1 s2.0 S0140673618322797 Main

Global Health Metrics
Global, regional, and national incidence, prevalence, and

years lived with disability for 354 diseases and injuries for
195 countries and territories, 1990–2017: a systematic
analysis for the Global Burden of Disease Study 2017
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators*
Summary
Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a Lancet 2018; 392: 1789–858
comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in This online publication has been
195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates corrected. The corrected version
first appeared at thelancet.com
from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the
on June 20, 2019
non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world’s
*Collaborators listed at the end
population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, of the paper
ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving Correspondence to:
analytical strategies, and increasing the amount of high-quality data. Prof Christopher J L Murray,
Institute for Health Metrics
Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated Evaluation, University of
Washington, Seattle,
and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit WA 98121, USA
records, and health insurance claims, and additionally used results from cause of death models to inform estimates cjlm@uw.edu
using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil,
Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan
(province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of
estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each
condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of
each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI),
a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we
calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies
with the Guidelines for Accurate and Transparent Health Estimates Reporting.
Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache
disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the
greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent
tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron
deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and
depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates
decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased
by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100).
The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and
6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised
prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017
included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs 1400 [1279–1524] per
100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal
violence (3265 [2943–3630] vs 5643 [5057–6302]).
Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly
three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing
numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive
since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies
across the globe experiencing varying burdens and trends of health loss. This study emphasises how global
improvements in premature mortality for select conditions have led to older populations with complex and potentially
expensive diseases, yet also highlights global achievements in certain domains of disease and injury.
Funding Bill & Melinda Gates Foundation.
www.thelancet.com Vol 392 November 10, 2018 1789

Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Introduction rates of premature death but also failure in terms of

Measuring non-fatal health loss is one of the most maintaining health care for diseased and injured
complex endeavours in population health research. individuals. It is increasingly evident that differential
The evolution of modern health-care systems has led access to care, economic inequality, and imbalanced risk
to an increasing number of diseases and injuries factor profiles can and do challenge the ability of health
being diagnosed and treated in individual patients, systems to achieve equitable health outcomes in the face
and developments such as antihypertensive and statin of complex and resource-draining diseases and injuries.
medications, percutaneous coronary intervention, and Addressing such lapses in health equity can pose a
antiretroviral therapies have led to averted deaths and burden to under-resourced health care systems and
longer lives. In parallel with the increasing complexity of economies.
clinical medicine in the past century, measuring non- Global progress in improving the burden of non-fatal
fatal health loss has necessitated continuous refinement health outcomes has been limited, in part by a
as diagnostic classification systems expand, new diseases predominant focus on mortality rates as a common
emerge, and metrics of disability improve. Across the metric of tracking global health progress.1–3 In the latter
global landscape, increased non-fatal health loss para part of the 20th century, the global community focused
doxically reflects both success in terms of diminishing on communicable diseases such as tuberculosis, HIV,
Research in context
Evidence before this study rates to the inpatient admission per-capita estimates to more
The Global Burden of Diseases, Injuries, and Risk Factors (GBD) accurately measure the denominator for incident cases and
study is a comprehensive study of health loss designed to expanded the age range affected by protein-energy malnutrition.
capture complex patterns of disease and injury burden; for For cancer, we applied mortality-incidence ratios directly to
non-fatal health outcomes, these are measured in terms of cause-specific mortality rates to estimate incidence, and then
incidence, prevalence, and years lived with disability (YLDs). calculated prevalence on the basis of incidence and survival
Previous versions of the study have increased the estimation estimates. For mental and substance abuse disorders,
detail for conditions, locations, ages, and years. This study is a we adopted new covariates for opioid use and updated autism
reassessment of the incidence, prevalence, and YLDs of diseases spectrum disorder designations to be consistent with the most
and injuries from 1990 to 2017 and updates results from recent Diagnostic and Statistical Manual of Mental Disorders.
previous GBD studies. There are no alternative measurements We also added 19 new causes to our cause hierarchy, including
of non-fatal health loss that include the level of detail provided type 1 and type 2 diabetes, chronic kidney disease due
in the GBD study. to type 1 diabetes, and chronic kidney disease due to
type 2 diabetes; cirrhosis due to non-alcoholic steatohepatitis
Added value of this study
(NASH); liver cancer due to NASH; invasive non-typhoidal
This study adds new knowledge on non-fatal burden globally
salmonella; myelodysplastic, myeloproliferative, and other
and improves upon previous iterations of the GBD study in the
haemopoietic neoplasms; subarachnoid haemorrhage;
following ways. We expanded our database of non-fatal health
non-rheumatic valvular heart disease including calcific aortic and
outcomes by adding 2842 collaborator-provided data sources
degenerative mitral subtypes; aggregates of vision disorders and
and incorporating new clinical data representing an additional
hearing loss; poisoning by carbon monoxide; poisoning by other
149 million admissions and 3·7 billion outpatient visits for use in
means; and estimates for natures of injury (eg, fractures).
GBD modelling. This resulted in a total of 68 781 sources being
used in the estimation process for GBD 2017. We improved Implications of all the available evidence
estimation methods including updating the calculation of the Global non-fatal burden is continuing to increase despite minor
Socio-demographic Index (SDI), adding the ability to report the improvements in age-standardised rates. Three causes
statistical differences in non-fatal health outcomes for males and (low back pain, headache disorders, and depressive disorders)
females, using internally consistent GBD estimates of population have prevailed as leading causes of non-fatal health loss for
and fertility, and adopting several cause-specific modelling nearly three decades, while diabetes has emerged as the fourth
improvements. Cause-specific improvements included the leading cause of disability globally. The increase in YLDs reflects
following; for diarrhoea, we added additional literature an ageing global population commensurate with declines in
informing aetiological attribution; for HIV/AIDS, we updated premature mortality across the development spectrum.
absolute neutrophil count bias adjustments, antiretroviral Globally, patterns of non-fatal health loss vary dynamically by
therapy coverage data, and sex-specific survey estimates. For sex, age, location, SDI, and cause. The increasing burden of
hepatitis, we added case fatality rates and hepatitis B vaccine non-fatal diseases, injuries, and impairments could pose
coverage to viral hepatitis incidence models. For maternal, considerable challenges to health systems and economies not
neonatal, and child health causes, we added in-facility delivery equipped to care for complex and expensive conditions.
1790 www.thelancet.com Vol 392 November 10, 2018

malaria, and other conditions that cause premature despite different collection methods or case definitions;
mortality. In the past decade, it has become evident to find a consistent set of estimates between data on
that measuring non-fatal health loss is important for prevalence, incidence, and causes of death; and to predict
tracking progress as the disease burden, in terms of estimates for locations and causes with sparse or absent
disability-adjusted life-years (DALYs), evolves toward data by borrowing information from other locations and
being dominated by years lived with disability (YLDs). covariates.
Transitions in ageing populations and reduced mortality The study conducts annual updates to incorporate
in many areas of the world have created dynamic new causes and data (including published literature,
temporal patterns, particularly within the past decade, surveillance data, survey data, hospital and clinical data,
and measuring such time patterns is important because and other types of data) and to improve demographic and
advents such as developing a cure for hepatitis C, statistical methods. In this study, we apply different
discovering new therapies for cancer, and improving methods to utilise available data and to measure specific
treatments for HIV can rapidly transform the burden in epidemiological patterns of each cause of non-fatal
populations with access to these developments, and as burden. Our standard approach uses the Bayesian meta-
conditions such as diabetes and non-alcoholic fatty liver regression tool DisMod-MR 2.1. Subsequently, we use
disease become increasingly prevalent in lower-income data for severity and the occurrence of particular con
countries.4 sequences of diseases, or sequelae, to establish the
Estimates reported in recent iterations of the Global proportion of prevalent cases experiencing each sequela.
Burden of Diseases, Injuries, and Risk Factors Study There are several classes of alternative approaches for
(GBD) have also illustrated differential health outcomes in estimating non-fatal health outcomes, including for
males and females in certain locations and conditions. injuries, cancers, HIV/AIDS, other infectious diseases,
This topic has received attention in terms of mortality and neonatal disorders. Presented below is a high-level
rates for sex-specific conditions such as maternal causes,5–9 description of our study methods; the supplementary
gynaecological and breast malignancies,10–13 and long-term methods (appendix 1 section 4) provide further detail on See Online for appendix 1
complications of obstructed labour, such as obstetric inputs, analytical processes, and outputs and methods
fistula.14–18 GBD 2016 also highlighted how global, age- speciﬁc to each cause in GBD 2017.
standardised, all-cause YLD rates are approximately Analyses were completed using Python version 2.7,
10% higher in females than males, emphasising how Stata version 13.1, or R version 3.3. Statistical code
there may be sex-specific characteristics of the non-fatal used for GBD estimation is publicly available online. All For the statistical code see
burden that have not been explored in detail, particularly rates are expressed as age-standardised based on the https://github.com/ihmeuw/
ihme-modeling
with respect to the differences in sex-specific health GBD reference population19 unless otherwise specified.
outcomes.2 It is increasingly of interest to measure This study complies with the Guidelines for Accurate
differences in male and female non-fatal health loss. and Transparent Health Estimates Reporting (GATHER)20
This year’s GBD study represents the continued effort recommendations (appendix 1).
of quantifying non-fatal health outcomes in terms of
incidence, prevalence, and YLDs for a list of 354 GBD Geographical units, time periods, and demographics
causes for the years 1990–2017. Because the study is GBD 2017 is based on a geographical hierarchy that
remeasured and published on an annual basis, new includes 195 countries and territories grouped into
estimates are provided not only for new estimation years 21 regions and seven GBD super-regions (appendix 1).
but also for all previous estimation years and supersede Each year, GBD includes subnational analyses for a few
any previous results. This year’s study on non-fatal new countries and continues to provide subnational
burden incorporates improvements in study design, estimates for countries that were added in previous cycles.
estimation strategy, and data availability, and focuses on Subnational estimation in GBD 2017 includes five new
areas of non-fatal burden that are emerging as topical countries (Ethiopia, Iran, New Zealand, Norway, Russia)
issues in measuring and improving health outcomes. We and countries previously estimated at subnational levels
also explore the patterns of non-fatal health loss over (GBD 2013: China, Mexico, and the UK [regional level];
time and estimate the statistical differences in non-fatal GBD 2015: Brazil, India, Japan, Kenya, South Africa,
health loss for males and females. Sweden, and the USA; GBD 2016: Indonesia and the UK
[local government authority level]). All analyses are at the
Methods first level of administrative organisation within each
Overview country except for New Zealand (by Māori ethnicity),
The GBD study provides a standardised approach for Sweden (by Stockholm and non-Stockholm), and the UK
estimating incidence, prevalence, and YLDs by cause, (by local government authorities). All subnational
age, sex, year, and location. The study aims to use all estimates for these countries were incorporated into
accessible information on disease occurrence, natural model development and evaluation as part of GBD 2017.
history, and severity that passes a set of inclusion criteria. To meet data use requirements, in this publication we
Our objective is to maximise the comparability of data, present all subnational estimates excluding those pending

publication (Brazil, India, Japan, Kenya, Mexico, Sweden, We have grouped the 47 nature of injury sequelae into
the UK, and the USA); given space constraints these seven combined categories that represent 1410 sequelae.
results are presented in appendix tables and figures The supplementary methods (appendix 1) includes the
See Online for appendix 2 instead of in the main text (appendix 2). Subnational full GBD 2017 non-fatal reporting hierarchy from
estimates for countries with populations larger than Level 1 to Level 6.
200 million people (measured using our most recent
year of published estimates) that have not yet been Data sources
published elsewhere are presented wherever estimates The process for non-fatal estimation begins with the
are illustrated with maps but are not included in data compilation of data sources from a diverse set of possible
For the Global Health Data tables. Cause-specific results for non-fatal estimates for sources, which include 21 possible Global Health Data
Exchange see http://ghdx. GBD 2017 cover the years 1990–2017. A subset of areas in Exchange (GHDx) data types ranging from scientific
healthdata.org
this analysis focuses on 1990, 2007, and 2017 to show literature to survey data to epidemiological surveillance
changes over time to better inform policy assessments. data. Our collaborator network provided 2842 data
GBD 2017 is the first time that estimation of fertility sources for GBD 2017. We analysed 21 100 sources of
and population has been done within the GBD frame epidemiological surveillance data (country-years of
work. Previously, the GBD study used external disease reporting) for GBD 2017 and 4734 sources of
sources21,22 for fertility and population estimates, which disease registry data. For non-fatal estimation, we did
affect estimates throughout the GBD study, particularly systematic data and literature searches for 82 non-fatal
estimates expressed in terms of population rates. The causes and one impairment, which were updated to
purpose of using internally derived demographic Feb 11, 2018. Search terms used for cause-specific
estimates is to ensure internal consistency across all systematic reviews, inclusion and exclusion criteria,
GBD estimates. That is, mortality rates and fertility preferred and alternative case definitions, and study
rates have to match population rate change such that methods detailed by cause are available in the
there should be no births, deaths, or migrations that are supplementary methods (appendix 1 section 4). This
not accounted for in our population estimates. search process contributed to the use of 15 449 scientific
literature sources and 3126 survey sources used in
GBD cause list non-fatal estimation, reflecting our updated counting
In GBD 2017, we further refined the existing cause list, criteria for GBD 2017. Household survey data archived
and added 19 new causes, increasing the number of in the GHDx were systematically screened together
estimated causes in GBD to 359 with 282 causes of death with sources suggested by country-level experts, surveys
estimated and 354 causes of non-fatal health loss located in multinational survey data catalogues, and
estimated. In the GBD study, causes and their sequelae Ministry of Health and Central Statistical Office websites.
are organised into hierarchical levels. Level 1 contains Primary data sources containing disease prevalence,
three broad cause groups: communicable, maternal, incidence, mortality risk, duration, remission, or severity
neonatal, and nutritional diseases (CMNN); non- were then combined in the estimation process. The
communicable diseases (NCDs); and injuries. For non- supplementary methods section provides further details
fatal health estimates, there are 22 Level 2 causes, on gold standard data sources, adjustments, correction
167 Level 3 causes, and 288 Level 4 causes. We also report factors, and standardisations employed when incorpo
estimates for 3484 sequelae, nine impairments, and rating these different types of non-fatal data (appendix 1
seven nature of injury aggregates. section 4).
In addition to data sources based on primary literature,
New for GBD 2017 surveys, and surveillance, the GBD study has used an
In GBD 2017, we report on 381 Level 5 sequelae. We have increasing number of hospital discharge records, out
opted to include aggregate sequelae for GBD 2017 to patient visit records, and health insurance claims to
foster more nuanced interpretations of groups of health inform various steps of the non-fatal modelling process.
outcomes that are relevant to policy makers and clinical This year, we received hospital discharge records for an
users of the GBD. In addition, this reporting list allows additional 30 country-years, specifically discharge records
for more detailed evaluation of aetiologies and outcomes from India (3 country-years), Iran (10), Japan (6), Jordan
from GBD causes. (1), Nepal (1), Brazil (2), China (1), and Italy (6); inpatient
For the first time in the GBD study, we present the and outpatient claims from Taiwan (province of China);
burden of injuries in terms of nature of injury as well as additional years of inpatient and outpatient claims
external cause of injury. Previously, we reported the from the USA; and inpatient claims from Singapore,
incidence, prevalence, and YLDs of injuries expressed representing an additional 148 842 107 hospital admis
only in terms of what caused the injury—eg, those sions globally and bringing the total number of
caused by falls. However, the burden that results from admissions that inform GBD estimation to more than
falls is experienced in terms of the bodily harm that the 2·6 billion. Additionally, we received 10 years of out
fall itself causes—eg, spinal injury or skeletal fracture. patient visit records from Norway, representing a total of

153 351 282 outpatient visits over a 10-year period. Overall, injury outcomes. Estimation occurred at the five levels of
the study now uses hospital data from 335 country-years, the GBD location hierarchy—global, super-regional,
outpatient visit data from 45 country-years, and health regional, national, and subnational—with results of each
insurance claims data from 33 country-years between higher level providing guidance for the analysis at the
the USA, Taiwan (province of China), and Singapore. lower geographical level. Important modelling strategy
These data inform multiple cause models in various changes from GBD 2016 to GBD 2017 for specific causes,
ways, mainly by providing incidence and prevalence as well as further details on these causes and their
estimates adjusted for readmission, non-primary diag respective models, can be found in the supplementary
nosis, outpatient utilisation, or a combination of the methods (appendix 1 section 4).
above, but also by estimating parameters such as case Custom models were created if DisMod-MR 2.1 did not
fatality rates, remission rates, procedure rates, and capture the complexity of the disease or if incidence and
distribution of disease subtypes. The supplementary prevalence needed to be calculated from other data, or
methods provide a more detailed description of how the both. Further details of these custom models can be
clinical data adjustments are calculated and how found in the cause-specific methods sections of the
admission and outpatient visit data are processed and supplementary methods (appendix 1 section 4).
utilised (appendix 1 section 2). Prevalence was estimated for nine impairments,
In the supplementary methods (appendix 1), we show defined as sequelae of multiple causes for which better
the geographical coverage of non-fatal data, both data were available to estimate the overall occurrence
incidence and prevalence, for GBD 2017. In addition, we than for each underlying cause: anaemia, intellec
illustrate the non-fatal data density and availability for tual disability, epilepsy, hearing loss, vision loss, heart
GBD 2017 from 1990 to 2017 by GBD region and year for failure, infertility, pelvic inflammatory disease, and
each of the three Level 1 GBD cause groups. The GHDx Guillain-Barré syndrome. Different methodological app
provides the metadata for all sources used for non-fatal roaches were used for each impairment estimation
estimation. process; these details are described in the supplementary
methods (appendix 1 section 4).
Non-fatal disease models
For GBD 2017, we modelled non-fatal disease burden Severity distributions and disability weights
using DisMod-MR 2.1, a meta-analysis tool that uses Severity splits apply a set of proportions that represent the
a compartmental model structure with a series of distribution of cases of a given non-fatal cause by its
differential equations that synthesise sparse and hetero underlying severities. Severity splits are typically cate
geneous epidemiological data for non-fatal disease and gorised as asymptomatic, mild, moderate, and severe. This
Communicable, maternal, neonatal, Non-communicable diseases Injuries

and nutritional diseases
Central Asia
Central Europe
Eastern Europe
Australasia
High-income Asia Pacific
High-income North America
Southern Latin America
Western Europe
Andean Latin America
Caribbean
Central Latin America
Tropical Latin America
North Africa and Middle East
South Asia
East Asia
Oceania
Southeast Asia
Central sub-Saharan Africa
Eastern sub-Saharan Africa
Southern sub-Saharan Africa
Western sub-Saharan Africa
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Year Year Year

Data availability
≥10 site-years ≥50 site-years ≥100 site-years ≥150 site-years
Figure 1: Non-fatal data availability in terms of site-years by GBD region and year for Level 1 causes of burden, 1990–2017
This figure represents non-fatal data from 1990 to 2017, showing the number of site-years for each location-year combination for each Level 1 cause of burden by GBD region.

distinction is important for conditions such as asthma that of development.26 The SDI was originally constructed for
have a broad spectrum of symptomatic severities. Severity GBD 2015 using the Human Development Index (HDI)
splits for most conditions use the Medical Expenditure methodology, wherein a 0–1 index value was determined
Panel Survey (MEPS) data or literature sources identified for each of the original three covariate inputs (total
through systematic reviews. Further detail on the severity fertility rate in women aged 15–49 years, educational
splits for each cause, including changes from GBD 2016, attainment over the age of 15 years, and lag-distributed
are available in the cause-specific modelling write-ups in income per capita) using the observed minima and
the supplementary methods (appendix 1 section 4). maxima over the estimation period to set the scales. In
Disability weight estimation is described in more detail response to feedback from collaborators, we have refined
elsewhere in the literature,23 but in summary, these the indicator with each GBD cycle. For GBD 2017, we
represent the severity of health loss associated with a replaced the total fertility rate with the total fertility rate in
single given health state. The supplementary methods women under the age of 25 years. The GBD 2017
(appendix 1) provide a complete listing of the lay Population and Fertility24 analysis of age-specific fertility
descriptions of all 234 health states used in the estimation rates revealed that through the process of development,
of non-fatal results for GBD 2017. many countries exhibited a decline in age-specific fertility
rates over the age of 30 years and then increased, creating
Comorbidity a U-shaped pattern; however, age-specific fertility rates in
A combined disability weight is required to account for ages 10–14 years, 15–19 years, 20–24 years, and total
individuals with more than one condition. To calculate a fertility under 25 years did not exhibit this pattern. Total
combined disability weight, the health loss associated fertility under 25 years remains highly correlated with
with two disability weights are multiplied together and mortality measures including under-5 mortality rates
then a weighted average of each constituent disability (Pearson’s correlation coefficient r=0·873), and results
weight is calculated. The adjusted disability weight is from this revised method for computing SDI and results
proportional to the magnitude of the original disability from GBD 2016 are also correlated (r=0·992).24 We
weight. A simulation of 40 000 distinct individuals is computed the composite SDI as the geometric mean of
done that calculates the distribution of comorbid con the three indices for each location-year. The cutoff values
ditions on the basis of the expected distribution of used to determine quintiles for analysis were then
each condition’s sequelae in the population. Then, the computed using country-level estimates of SDI for 2017,
resulting distributions of comorbidity-adjusted disability excluding countries with populations of less than
weights are used to calculate YLDs. This process did not 1 million. These quintiles are used to categorise and
change from GBD 2016. present GBD 2017 results on the basis of sociodemographic
status. The SDI values ranged from a low of 0·191 in
YLD computation Niger to a high of 0·918 in Denmark in 2017. Additional
YLDs were estimated as the product of prevalence details on and results from the SDI calculation are
estimate and a disability weight for health states of each available in the supplementary methods (appendix 1
mutually exclusive sequela, adjusted for comorbidity as section 2).
described above. The GBD cause hierarchy also includes
35 residual disease categories to capture YLDs from Role of the funding source
conditions that lack specific estimation models. The funder of the study had no role in study design, data
collection, data analysis, data interpretation, or writing
Uncertainty analysis the report. All authors had full access to the data in the
We apply the same technique for propagating uncertainty study and had final responsibility for the decision to
as used elsewhere in the GBD study design.19,24,25 The submit for publication.
distribution of every step in the computation process is
stored in 1000 draws that are used for every other step Results
in the process. The distributions are determined from Global prevalence, incidence, and YLDs
the sampling error of data inputs, the uncertainty of Non-fatal estimates by cause for 354 causes and nine
the model coefficients, and the uncertainty of severity impairments for the years 1990, 2007, and 2017 are
For the online results tool see distributions and disability weights. Final estimates are available by age and sex through the online results tool.
https://collab2017.healthdata. computed using the mean estimate across 1000 draws, Results and findings mentioned in the discussion can
org/gbd-search
and the 95% uncertainty intervals (UIs) are determined also be viewed interactively through an online data
For the online data visualisation
on the basis of the 25th and 975th ranked values across visualisation tool.
tool see https://vizhub.
healthdata.org/gbd-compare all 1000 draws. Figure 1 shows the data density in terms of site-years by
GBD region, cause group, and year. The figure shows
The Socio-demographic Index how data density generally improves over time and how
The Socio-demographic Index (SDI) is a summary certain regions, particularly higher income regions, are
measure that estimates a location’s position on a spectrum more data dense than others. Additionally, the figure

highlights how injuries data are generally less available 100 000, representing a 3·9% (3·1–4·6) decrease. CMNN
than for the other two cause groups. causes accounted for 13·8% (12·5–15·1) of total YLDs in
Table 1 reports cause-specific global estimates of 2017, while NCDs accounted for 79·5% (77·8–81·1) and
prevalence, incidence, and YLDs for causes at Levels 1–5 injuries for 6·7% (6·2–7·3), with a total of 118 million
of the GBD hierarchy for 2017, as well as the percentage (86·7–154) YLDs for CMNN causes, 678 million (510–876)
change in YLDs and age-standardised YLD rates between for NCDs, and 57·2 million (42·1–75·4) for injuries. The
1990, 2007, and 2017. Unless otherwise specified, all rates number of YLDs from CMNN causes increased from
reported in this analysis are age standardised. 1990 to 2017 by 13·6% (9·15–19·2), and the YLD rates
from CMNN causes decreased by 14·8% (10·7–18·0)
Prevalence from 1846 YLDs (1343–2472) to 1573 YLDs (1159–2067) per
For all ages and both sexes combined, globally, in 2017, 100 000 during the same period. The number of YLDs
the three most common causes at Level 3 of the GBD from NCD causes increased between 1990 and 2017 by
cause hierarchy in terms of all-age prevalent cases were 61·1% (60·0–62·4), and the YLD rate from these causes
oral disorders (3·47 billion, 95% UI 3·27–3·68), headache decreased by 1·2% (0·66–1·8) from 8684 YLDs
disorders (3·07 billion, 2·90–3·27), and tuberculosis (6540–11 223) to 8579 YLDs (6454–11 084) per 100 000. The
including latent tuberculosis infection (1·93 billion, number of YLDs from injuries increased between 1990
1·71–2·20; table 1). and 2017 by 52·7% (49·3–56·4), and the YLD rate from
Global age-standardised prevalence rankings remained injuries decreased by 7·8% (6·27–9·28) from 779
unchanged for the top two Level 3 causes in the GBD (577–1023) YLDs to 719 YLDs (529–948) per 100 000. In
hierarchy from 1990 to 2017, with oral disorders and 2017, the YLD rate for all causes ranged from 9120 YLDs
headache disorders remaining the two most common (6877–11 622) per 100 000 in Columbia to 14 824 YLDs
causes. Tuberculosis including latent tuberculosis infec (11 080–19 203) per 100 000 in Yemen.
tion was the third leading cause in 1990 and became the Globally, in 1990, for all ages and both sexes, the
fourth leading cause in 2017, whereas haemoglobin leading Level 3 causes of YLDs were low back pain
opathies were the fourth leading cause in 1990 and (42·5 million YLDs, 95% UI 30·2 to 57·2), headache
became the third leading cause in 2017. Between 1990 disorders (35·1 million, 22·8 to 49·7), and dietary iron
and 2017, the age-standardised prevalence decreased for deficiency (31·7 million, 21·6 to 45·5). Between 1990 and
oral disorders by 5·5% (95% UI 4·9 to 6·0) but increased 2007, the number of all-age YLDs attributed to low
for headache disorders by 0·3% (−0·2 to 0·9) and for back pain increased by 30·0% (27·9 to 31·9) and
haemoglobinopathies by 4·7% (4·3 to 5·1). those attributed to headache disorders increased
by 34·0% (33·0 to 35·1), while the number of all-age
Incidence YLDs for dietary iron deficiency decreased by 0·2%
Globally, in 2017, for all ages and both sexes combined, the (−2·8 to 2·2). Between 1990 and 2007, the number of all-
three leading Level 3 causes in terms of incident cases age YLDs attributed to depressive disorders increased by
were upper respiratory infections (17·1 billion, 95% UI 33·4% (31·0 to 35·8), becoming the third leading cause
15·3 to 19·2), diarrhoeal diseases (6·29 billion, of all-age YLDs in 2007, and shifting dietary iron
5·81 to 6·82), and oral disorders (3·60 billion, 3·23 to 3·99; deficiency to fourth; the rankings for low back pain and
table 1). These case rankings remained unchanged for the headache disorders did not change from 1990 to 2007.
top three causes between 1990 and 2017 despite a decrease From 2007 to 2017, we observed further increases in the
in age-standardised incidence rates of upper respiratory number of all-age YLDs attributable to the leading three
infections of 2·6% (95% UI 2·0 to 3·1), from 232 815 new causes: low back pain (17·5%, 95% UI 16·2–19·0),
cases (95% UI 207 461 to 260 397) to 226 802 new cases headache disorders (15·4%, 14·6–16·2), and depressive
(201 716 to 253 367) per 100 000, and in age-standardised disorders (14·3%, 13·1–15·6).
incident rates of oral disorders of 0·3% (−1·1 to 0·6), from Figure 2 illustrates the leading Level 3 causes of YLD
48 423 new cases (43 233 to 53 971) to 48 276 new cases rates by GBD country and select subnational locations in
(43 109 to 53 919) per 100 000, and an increase in the 2017 for both sexes combined. The geographical variation
number of new cases per 100 000 of diarrhoeal diseases of in the leading Level 3 causes of YLD rates across
11·7% (8·8 to 14·6), from 75 087 new cases (69 475 to 81 367) countries is shown: low back pain was the leading cause
to 83 846 new cases (77 402 to 90 965) per 100 000. in 126 of the 195 countries and territories whereas
diabetes was the leading cause of YLD rates in Mexico,
YLDs Equatorial Guinea, Congo (Brazzaville), Myanmar,
The global number of YLDs increased from 562 million Mauritius, and Gabon, as well as parts of the Caribbean
(95% UI 421–723) to 853 million (642–1097) between and most of Oceania. Dietary iron deficiency was the
1990 and 2017, representing a 51·8% (50·2–53·5) increase leading cause of YLD rates in Yemen, India, Antigua and
and a 7·2% (6·0–8·4) increase in the all-age YLD rate, Barbuda, and in parts of western sub-Saharan Africa.
while age-standardised YLD rates decreased from Conflict and terrorism was the leading cause of YLDs in
11 310 YLDs (8485–14 506) to 10 871 YLDs (8171–13 980) per Afghanistan, Eritrea, Rwanda, and Burundi.

Prevalence (thousands) Incidence (thousands) YLDs (thousands)

2017 counts 2017 counts
2017 counts Percentage Percentage Percentage change Percentage change
change in counts, change in counts, in age-standardised in age-standardised
1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
All causes 7 369 526·2 38 480 253·2 853 042·6 29·8% 17·0% −3·0% −0·9%
(7 344 769·0 to (36 469 390·1 to (642 084·6 to (28·8 to 30·8)* (16·4 to 17·6)* (−3·5 to −2·5)* (−1·4 to −0·4)*
7 392 430·8) 40 567 963·0) 1 097 347·2)
Communicable, maternal, 4 767 056·2 27 145 980·3 117 573·7 10·6% 2·6% −7·8% −7·6%
neonatal, and nutritional (4 646 620·9 to (25 247 991·1 to (86 670·4 to (7·4 to 14·8)* (0·5 to 5·5)* (−10·4 to −4·5)* (−9·6 to −5·0)*
diseases 4 904 464·9) 29 151 315·9) 154 424·2)
HIV/AIDS and sexually 1 238 129·2 769 111·2 5369·7 204·0% −6·0% 130·4% −17·6%
transmitted infections (1 129 539·6 to (694 471·1 to (3783·6 to 7272·2) (136·7 to 302·7)* (−20·6 to 8·3) (79·8 to 202·8)* (−30·5 to −4·7)*
1 359 466·0) 850 896·0)
HIV/AIDS 36 822·2 1942·1 3949·0 372·9% −11·5% 257·8% −22·6%
(34 794·9 to 39 199·8) (1632·1 to 2287·5)† (2746·5 to 5419·1) (299·6 to 489·2)* (−26·2 to 5·4) (204·6 to 343·0)* (−35·7 to −7·8)*
HIV/AIDS and 1049·5 1321·6 404·7 329·9% −19·6% 229·1% −29·2%
drug-susceptible tuberculosis (956·6 to 1149·6) (1203·1 to 1454·8) (272·3 to 546·5) (316·0 to 345·1)* (−21·8 to −17·3)* (219·0 to 240·1)* (−31·1 to −27·2)*
co-infection
HIV/AIDS and 37·6 52·0 15·3 3509·4% −23·4% 2591·5% −32·9%
multidrug-resistant (25·2 to 54·5) (37·5 to 71·2) (9·0 to 24·4) (1734·6 to (−47·9 to 12·8) (1256·0 to (−54·5 to −1·1)*
tuberculosis without 6384·8)* 4788·1)*
extensive drug resistance
co-infection
HIV/AIDS and extensively 1·4 1·7 0·6 ·· 37·1% ·· 19·5%
drug-resistant tuberculosis (0·9 to 2·3) (1·2 to 2·3) (0·3 to 1·0) (−12·3 to 116·5) (−23·8 to 88·6)
co-infection
HIV/AIDS resulting in other 35 733·7 1942·1 3528·5 376·9% −10·4% 260·2% −21·7%
diseases (33 669·3 to 38 076·0) (1632·1 to 2287·5) (2439·7 to 4941·4) (292·0 to 510·8)* (−26·9 to 9·3) (199·6 to 357·9)* (−36·3 to −4·5)*
HIV/AIDS not on 14 763·0 1942·1 1911·1 343·8% −47·8% 235·0% −53·9%
antiretroviral treatment (13 278·6 to 16 643·9) (1632·1 to 2287·5) (1240·9 to 2928·7) (257·7 to 481·8)* (−52·9 to −42·9)* (172·5 to 332·7)* (−58·4 to −49·5)*
without tuberculosis
HIV/AIDS on 20 970·7 ·· 1617·4 2 265 649·4% 491·3% 1 847 617·4% 404·7%
antiretroviral treatment (19 876·1 to 22 058·6) (1079·5 to 2267·1) (1 200 289·1 to (420·4 to 581·8)* (1 009 483·5 to (343·7 to 482·1)*
without tuberculosis 5 966 377·3)* 4 566 992·3)*
Sexually transmitted 1 216 425·2 767 169·1 1420·7 33·8% 13·4% 0·8% 0·8%
infections excluding HIV (1 107 618·8 to 1 337 882·9) (692 748·8 to 849 178·3) (764·5 to 2552·2) (32·1 to 35·3)* (12·1 to 14·8)* (−0·2 to 1·5) (−0·3 to 1·8)
Syphilis 36 388·6 10 263·8 72·9 28·7% 18·5% −10·8% −3·5%
(31 030·7 to 42 960·2) (8574·2 to 11 991·1) (50·9 to 98·3) (25·1 to 33·0)* (15·7 to 21·5)* (−13·8 to −7·4)* (−5·8 to −1·2)*
Early syphilis 36 018·0 10 263·8 8·6 36·6% 13·7% 5·0% 2·2%
(30 662·1 to 42 602·0) (8574·2 to 11 991·1) (2·6 to 21·9) (32·5 to 40·8)* (10·1 to 17·1)* (2·2 to 7·8)* (−1·0 to 5·3)
Tertiary syphilis 370·6 ·· 64·3 27·7% 19·2% −12·5% −4·2%
(319·8 to 420·3) (43·9 to 88·2) (23·9 to 32·2)* (16·1 to 22·5)* (−15·3 to −9·4)* (−6·5 to −1·8)*
Chlamydial infection 109 822·0 297 131·3 314·6 30·9% 10·1% 0·3% −0·7%
(93 827·4 to 128 829·4) (247 050·0 to 358 150·1) (179·4 to 565·4) (28·5 to 33·7)* (7·7 to 12·7)* (−1·0 to 2·0) (−2·7 to 1·6)
Chlamydia episode 104 561·0 297 131·3 175·0 29·0% 9·0% −1·0% −1·7%
(88 447·0 to 123 536·5) (247 050·0 to 358 150·1) (68·4 to 379·5) (26·4 to 31·4)* (7·7 to 10·3)* (−1·7 to −0·3)* (−2·4 to −1·0)*
Chlamydial infection 5261·1 ·· 139·6 33·5% 11·6% 2·1% 0·7%
complications (4960·3 to 5607·8) (92·2 to 195·6) (28·8 to 38·4)* (6·5 to 16·6)* (−1·0 to 5·2) (−3·8 to 5·2)
Gonococcal infection 47 269·2 137 221·5 190·3 27·0% 10·2% 1·3% 1·9%
(36 099·9 to 61 106·1) (105 854·1 to 173 538·4) (102·2 to 356·6) (24·1 to 30·5)* (6·8 to 14·4)* (−0·5 to 3·3) (−1·3 to 5·6)
Gonococcal infection 1705·4 ·· 68·9 31·9% 16·9% 2·6% 6·6%
complications (1596·2 to 1824·5) (45·3 to 97·9) (26·9 to 36·9)* (9·7 to 24·5)* (−1·1 to 6·4) (0·1 to 13·5)*
Gonorrhoea episode 45 563·8 137 221·5 121·3 24·7% 6·7% 0·7% −0·5%
(34 373·4 to 59 361·5) (105 854·1 to 173 538·4) (46·5 to 271·5) (22·1 to 28·0)* (2·9 to 9·9)* (−0·9 to 2·6) (−4·2 to 2·7)
Trichomoniasis 142 114·5 244 855·9 242·8 37·7% 16·0% 2·9% 2·2%
(118 989·2 to 170 489·8) (208 226·8 to 289 024·3) (97·6 to 523·8) (35·4 to 40·1)* (14·2 to 17·7)* (1·9 to 3·8)* (1·1 to 3·2)*
Genital herpes 955 894·8 77 696·7 247·4 41·7% 19·8% 1·9% 1·5%
(847 327·5 to 1 087 446·6) (68 687·0 to 87 707·7) (79·8 to 593·7) (39·0 to 43·3)* (18·1 to 21·0)* (1·1 to 2·8)* (0·9 to 2·3)*
Other sexually transmitted 11 860·5 ·· 352·7 33·9% 11·2% 1·8% 0·8%
infections (11 121·7 to 12 735·7) (214·9 to 598·5) (31·9 to 36·2)* (9·6 to 13·1)* (0·7 to 3·1)* (−0·6 to 2·3)
(Table 1 continues on next page)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
(Continued from previous page)
Other sexually transmitted ·· ·· 193·3 27·2% 7·8% −0·0% −0·6%
diseases residual (105·6 to 361·3) (25·3 to 29·5)* (5·7 to 10·4)* (−1·2 to 1·4) (−2·6 to 1·7)
Other sexually 11 860·5 ·· 352·7 33·9% 11·2% 1·8% 0·8%
transmitted diseases (11 121·7 to 12 735·7) (214·9 to 598·5) (31·9 to 36·2)* (9·6 to 13·1)* (0·7 to 3·1)* (−0·6 to 2·3)
Respiratory infections and 2 187 290·0 17 942 622·2 11 670·3 16·2% 9·8% −6·9% −2·6%
tuberculosis (1 979 143·1 to (16 102 037·4 to (7845·9 to (14·9 to 17·6)* (8·9 to 10·7)* (−8·3 to −5·7)* (−3·6 to −1·7)*
2 449 760·7) 20 038 445·4) 16 749·7)
Tuberculosis 1 929 208·6 8965·8 3120·4 16·3% 9·4% −13·9% −7·6%
(1 710 952·7 to 2 199 199·9) (8191·8 to 9820·8) (2133·6 to 4230·6) (14·6 to 18·0)* (7·8 to 11·2)* (−15·1 to −12·7)* (−8·8 to −6·5)*
Latent tuberculosis 1 918 892·1 ·· ·· ·· ·· ·· ··
infection (1 701 127·1 to 2 187 433·5)
Drug-susceptible 9828·6 8508·6 2969·7 11·4% 9·6% −17·5% −7·5%
tuberculosis (8860·7 to 10 773·9) (7808·6 to 9371·0) (2011·4 to 4077·3) (9·4 to 13·5)* (5·2 to 12·7)* (−18·9 to −16·1)* (−11·1 to −5·1)*
Multidrug-resistant 464·1 432·8 142·8 589·4% 4·8% 399·5% −11·8%
tuberculosis without (229·1 to 863·3) (254·6 to 726·9) (66·6 to 281·1) (189·9 to (−45·2 to 76·4) (110·5 to 1218·1)* (−53·5 to 48·1)
extensive drug resistance 1708·7)*
Extensively drug-resistant 23·7 24·5 7·9 ·· 44·8% ·· 20·9%
tuberculosis (13·9 to 44·1) (17·7 to 35·0) (4·1 to 15·1) (−11·7 to 157·8) (−26·3 to 115·5)
Lower respiratory infections 10 638·1 471 825·5 648·9 3·2% 15·8% −11·1% 4·4%
(9729·1 to 11 559·4) (429 571·3 to 516 976·9) (432·6 to 927·7) (0·3 to 6·3)* (11·8 to 20·1)* (−13·0 to −9·3)* (0·5 to 8·4)*
Guillain-Barré syndrome 12·3 ·· 3·6 29·2% 17·9% 2·7% 3·1%
due to lower respiratory (6·9 to 19·9) (1·7 to 6·6) (25·3 to 33·5)* (15·5 to 20·6)* (1·1 to 4·3)* (1·9 to 4·2)*
infections
Lower respiratory infection 10 625·8 471 825·5 645·3 3·1% 15·8% −11·2% 4·5%
episode (9719·1 to 11 547·2) (429 571·3 to 516 976·9) (429·9 to 925·0) (0·1 to 6·1)* (11·8 to 20·1)* (−13·1 to −9·3)* (0·5 to 8·4)*
Upper respiratory infections 236 084·8 17 144 182·9 5866·0 19·6% 11·5% −2·5% 0·2%
(211 064·1 to 264 360·3) (15 334 493·4 to (3422·5 to 9336·4) (17·3 to 21·9)* (10·3 to 12·8)* (−3·3 to −1·8)* (−0·6 to 1·1)
19 211 715·4)
due to upper respiratory (24·4 to 44·7) (5·8 to 15·5) (25·3 to 33·4)* (15·5 to 20·6)* (1·1 to 4·3)* (1·9 to 4·2)*
infections
Upper respiratory infection 236 051·4 17 144 182·9 5856·2 19·6% 11·4% −2·5% 0·2%
episode (211 015·2 to 264 325·0) (15 334 493·4 to (3414·4 to 9325·9) (17·3 to 21·8)* (10·3 to 12·8)* (−3·3 to −1·8)* (−0·6 to 1·1)
19 211 715·4)
Otitis media 101 690·4 317 648·0 2034·8 11·6% 4·3% −5·8% −4·6%
(92 570·7 to 111 633·5) (254 458·5 to 397 736·6) (1230·7 to 3227·8) (8·9 to 14·5)* (1·8 to 7·0)* (−8·0 to −3·7)* (−6·9 to −2·2)*
Acute otitis media 18 153·8 317 625·1 238·4 10·7% 7·5% 4·6% 0·2%
(14 592·6 to 22 589·9) (254 441·2 to 397 715·6) (117·1 to 437·1) (8·2 to 13·6)* (5·2 to 9·7)* (2·5 to 7·1)* (−2·1 to 2·2)
Chronic otitis media 83 536·6 22·8 1796·4 11·7% 3·9% −7·1% −5·2%
(75 211·7 to 92 279·1) (0·8 to 81·8) (1107·7 to 2821·4) (8·7 to 14·9)* (1·0 to 7·0)* (−9·4 to −4·6)* (−7·8 to −2·5)*
Enteric infections 93 304·4 6 307 792·4 10 583·7 16·4% 23·6% −2·5% 9·7%
(86 780·5 to 99 732·5) (5 822 111·3 to (7283·3 to (13·6 to 19·4)* (20·6 to 26·9)* (−4·2 to −0·7)* (6·8 to 12·7)*
6 830 241·4) 14 516·1)
Diarrhoeal diseases 93 472·8 6 292 936·7 10 465·1 17·6% 24·5% −1·6% 10·4%
(86 857·2 to 99 961·1) (5 808 374·7 to (7203·1 to 14 386·3) (14·8 to 20·7)* (21·5 to 27·9)* (−3·4 to 0·3) (7·6 to 13·4)*
6 816 675·4)
due to diarrhoeal diseases (7·8 to 15·7) (2·0 to 5·4) (25·3 to 33·5)* (15·5 to 20·6)* (1·1 to 4·3)* (2·0 to 4·2)*
Diarrhoeal disease episode 93 461·4 6 292 936·7 10 461·7 17·6% 24·5% −1·6% 10·4%
(86 846·3 to 99 951·5) (5 808 374·7 to (7201·2 to 14 382·7) (14·7 to 20·7)* (21·5 to 27·9)* (−3·4 to 0·3) (7·6 to 13·4)*
6 816 675·4)
Typhoid and paratyphoid 387·5 14 321·1 114·9 −26·3% −24·9% −35·2% −30·4%
(312·6 to 467·9) (12 540·3 to 16 337·4) (77·7 to 164·2) (−32·0 to −20·7)* (−30·9 to −18·4)* (−39·8 to −30·4)* (−36·1 to −24·2)*
Typhoid fever 691·5 10 924·3 105·5 −26·4% −25·6% −35·2% −31·1%
(582·2 to 808·9) (9343·0 to 12 597·1) (70·3 to 151·0) (−32·5 to −20·4)* (−32·0 to −18·5)* (−40·2 to −29·8)* (−37·2 to −24·4)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Typhoid fever 144·0 1880·1 45·9 −26·0% −25·7% −34·9% −31·1%
complications (120·1 to 173·7) (1605·0 to 2191·0) (29·9 to 66·3) (−35·3 to −15·4)* (−35·6 to −14·3)* (−43·0 to −25·5)* (−40·6 to −20·4)*
Typhoid fever episode 547·5 9044·1 59·6 −26·7% −25·6% −35·4% −31·0%
(457·7 to 640·9) (7759·9 to 10 439·8) (39·3 to 87·0) (−33·8 to −18·5)* (−33·2 to −16·9)* (−41·6 to −28·5)* (−38·4 to −22·7)*
Paratyphoid fever 149·0 3396·9 9·4 −25·8% −15·8% −35·6% −22·0%
(117·0 to 185·1) (2666·5 to 4184·1) (5·9 to 13·9) (−32·5 to −18·1)* (−23·8 to −7·1)* (−41·2 to −29·2)* (−29·5 to −13·6)*
Intestinal perforation due 6·7 173·9 0·8 −26·4% −16·0% −36·0% −22·1%
to paratyphoid (5·2 to 8·4) (135·4 to 215·9) (0·5 to 1·1) (−34·5 to −17·6)* (−23·8 to −6·2)* (−42·9 to −28·8)* (−29·7 to −12·6)*
Paratyphoid fever 142·3 3222·9 8·6 −25·8% −15·8% −35·6% −21·9%
episode (111·5 to 176·8) (2537·7 to 3976·5) (5·4 to 12·8) (−32·7 to −17·7)* (−24·2 to −6·5)* (−41·4 to −28·7)* (−29·8 to −13·2)*
Invasive non-typhoidal 20·5 534·6 2·7 97·4% −20·9% 75·1% −26·9%
salmonella (14·5 to 28·6) (409·0 to 705·0) (1·6 to 4·3) (71·1 to 127·3)* (−30·1 to −9·7)* (52·6 to 101·3)* (−36·1 to −16·0)*
Other intestinal infectious ·· ·· 1·0 −40·9% −41·4% −45·3% −47·0%
diseases (0·6 to 1·4) (−47·2 to −33·9)* (−47·4 to −34·8)* (−50·8 to −39·2)* (−52·6 to −40·9)*
Neglected tropical diseases 1 278 896·5 357 652·1 13 622·9 2·4% −10·3% −19·2% −20·6%
and malaria (1 223 506·1 to (301 519·2 to (9498·3 to (−1·9 to 7·7) (−15·0 to −5·6)* (−22·5 to −15·4)* (−24·6 to −16·5)*
1 343 059·2) 431 965·1) 18 673·3)
Malaria 136 085·1 208 768·2 1468·0 14·1% −22·6% 0·3% −28·4%
(126 471·7 to 145 009·3) (170 214·0 to 257 506·0) (1034·0 to 2020·6) (4·7 to 24·4)* (−28·0 to −15·7)* (−8·0 to 9·1) (−33·4 to −22·0)*
Malaria complications 794·8 ·· 328·3 43·2% 26·8% 17·3% 17·4%
(723·8 to 875·7) (255·8 to 405·9) (38·1 to 49·0)* (22·2 to 31·8)* (13·1 to 21·9)* (13·1 to 22·1)*
Malaria episode 12 152·1 208 768·2 423·2 10·0% −22·1% −0·4% −27·5%
(7883·1 to 17 229·6) (170 214·0 to 257 506·0) (217·3 to 710·8) (−2·3 to 20·4) (−29·0 to −13·9)* (−11·4 to 9·4) (−34·2 to −19·6)*
Malaria parasitaemia 123 138·2 ·· 716·6 10·9% −34·5% −2·5% −39·3%
(112 779·9 to 133 815·6) (471·7 to 1056·9) (0·3 to 23·5)* (−40·4 to −27·0)* (−11·9 to 8·4) (−44·8 to −32·4)*
Chagas disease 6197·0 162·5 57·3 10·1% 2·0% −24·0% −17·8%
(5248·5 to 7243·9) (139·0 to 189·0) (38·3 to 82·5) (6·9 to 13·2)* (−1·4 to 5·7) (−26·1 to −21·8)* (−20·6 to −15·0)*
Acute Chagas disease 0·9 162·5 0·0 −16·2% −11·8% −32·1% −20·8%
(0·4 to 1·5) (139·0 to 189·0) (0·0 to 0·1) (−22·1 to −12·7)* (−14·4 to −8·9)* (−36·3 to −29·6)* (−23·1 to −18·5)*
Asymptomatic Chagas 5274·6 ·· ·· ·· ·· ·· ··
disease (4437·8 to 6166·6)
Symptomatic chronic 921·4 ·· 57·2 10·1% 2·0% −24·0% −17·8%
Chagas infection (731·1 to 1128·3) (38·3 to 82·4) (7·0 to 13·3)* (−1·4 to 5·7) (−26·1 to −21·8)* (−20·6 to −15·0)*
Leishmaniasis 4130·2 669·1 264·4 7·6% 30·1% −16·2% 14·1%
(3515·7 to 4966·8) (506·6 to 874·3) (172·4 to 389·6) (−8·7 to 29·4) (20·2 to 42·3)* (−28·2 to 1·1) (4·6 to 25·9)*
Visceral leishmaniasis 10·6 42·4 0·8 −96·0% −72·4% −96·4% −74·5%
(8·2 to 16·5) (32·9 to 66·1) (0·5 to 1·3) (−97·1 to −94·0)* (−79·4 to −58·3)* (−97·4 to −94·7)* (−81·0 to −61·3)*
Cutaneous and 4166·6 626·6 263·6 65·8% 31·5% 21·9% 15·3%
mucocutaneous (3560·7 to 4992·8) (460·0 to 834·2) (171·9 to 388·8) (35·6 to 126·1)* (21·2 to 44·2)* (0·0 to 66·3)* (5·2 to 27·4)*
leishmaniasis
African trypanosomiasis 4·9 3·3 1·3 −60·9% −79·1% −68·9% −81·2%
(1·3 to 19·8) (2·0 to 8·1) (0·3 to 5·3) (−69·0 to −47·0)* (−94·4 to −11·2)* (−75·4 to −58·4)* (−94·9 to −20·5)*
Trypanosomiasis 4·8 3·1 1·3 −60·3% −78·4% −68·5% −80·5%
Gambiense (1·3 to 19·6) (1·8 to 8·0) (0·3 to 5·3) (−69·1 to −44·4)* (−94·6 to −7·0)* (−75·6 to −56·3)* (−95·1 to −16·4)*
Trypanosomiasis 0·1 0·2 0·0 −67·7% −91·7% −74·2% −92·5%
Rhodesiense (0·0 to 0·3) (0·1 to 0·6) (0·0 to 0·1) (−81·9 to −46·6)* (−97·3 to −73·1)* (−85·6 to −57·6)* (−97·6 to −75·4)*
Schistosomiasis 142 788·5 ·· 1089·1 48·4% −20·7% 10·6% −30·0%
(131 656·9 to 155 480·2) (535·8 to 2082·0) (44·0 to 51·5)* (−22·2 to −19·2)* (7·3 to 13·0)* (−31·5 to −28·6)*
Mild schistosomiasis 114 409·2 ·· 642·0 53·2% −21·8% 13·1% −31·5%
(106 010·4 to 124 045·9) (259·2 to 1341·1) (51·5 to 54·7)* (−23·3 to −20·4)* (11·5 to 14·6)* (−32·9 to −30·1)*
Anaemia due to 7618·2 ·· 180·6 33·0% −30·4% −1·3% −38·6%
schistosomiasis (6901·9 to 8321·6) (119·1 to 268·6) (24·1 to 42·6)* (−35·1 to −25·9)* (−7·6 to 5·6) (−42·8 to −34·6)*
Schistosomiasis 20 785·2 ·· 266·5 50·9% −9·0% 15·7% −17·9%
complications (18 564·0 to 23 286·9) (146·7 to 472·7) (47·6 to 54·5)* (−11·9 to −4·3)* (12·7 to 18·5)* (−20·4 to −14·4)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Cysticercosis 5417·9 ·· 1568·5 13·5% 8·5% −17·7% −9·1%
(4662·0 to 6190·3) (1015·3 to 2181·0) (8·2 to 18·7)* (3·7 to 12·8)* (−21·3 to −14·2)* (−13·1 to −5·6)*
Cystic echinococcosis 589·5 139·6 48·3 33·5% 18·9% −1·0% 3·4%
(373·9 to 926·5) (90·2 to 213·9) (25·4 to 85·0) (26·3 to 41·9)* (12·4 to 25·5)* (−7·6 to 4·8) (−1·1 to 6·9)
Lymphatic filariasis 64 623·4 ·· 1364·0 25·5% −37·0% −6·4% −44·8%
(59 178·2 to 70 866·1) (752·0 to 2157·6) (4·6 to 37·4)* (−48·7 to −26·4)* (−22·0 to 2·3) (−54·7 to −35·5)*
Prevalence of detectable 52 285·4 ·· ·· ·· ·· ·· ··
microfilaria due to (48 689·8 to 55 843·9)
lymphatic filariasis
Lymphatic filariasis 12 338·1 ·· 1364·0 25·5% −37·0% −6·4% −44·8%
complications (8403·3 to 17 434·1) (752·0 to 2157·6) (4·6 to 37·4)* (−48·7 to −26·4)* (−22·0 to 2·3) (−54·7 to −35·5)*
Onchocerciasis 20 938·1 ·· 1342·9 −10·6% 3·9% −32·4% −8·0%
(12 882·3 to 37 227·7) (639·1 to 2371·9) (−15·5 to −4·3)* (−15·1 to 19·9) (−36·4 to −27·3)* (−25·8 to 6·7)
Asymptomatic 5131·9 ·· ·· ·· ·· ·· ··
onchocerciasis (35·8 to 18 859·4)
Skin disease due to 14 654·2 ·· 1246·9 −8·6% 3·7% −30·0% −7·5%
onchocerciasis (10 690·5 to 19 713·6) (552·7 to 2254·6) (−14·3 to −0·6)* (−18·4 to 20·3) (−34·7 to −23·6)* (−27·7 to 7·9)
Vision loss due to 1152·1 ·· 96·1 −31·6% 7·0% −52·9% −15·0%
onchocerciasis (829·0 to 1703·6) (60·6 to 141·5) (−36·5 to −26·5)* (−4·8 to 21·4) (−56·4 to −49·3)* (−24·3 to −3·8)*
Trachoma 3818·9 ·· 302·9 −12·8% −5·5% −41·8% −28·2%
(2842·6 to 5135·2) (201·7 to 425·1) (−18·2 to −6·4)* (−13·1 to 2·0) (−45·6 to −37·6)* (−33·8 to −22·5)*
Dengue 6267·4 104 771·9 1019·8 178·9% 61·1% 128·0% 45·2%
(3416·1 to 10 611·9) (63 759·0 to 158 870·0) (447·3 to 1909·6) (68·9 to 8404·5)* (41·3 to 148·0)* (38·1 to 6804·6)* (27·4 to 123·4)*
Post-dengue chronic 4418·2 ·· 911·1 179·0% 61·1% 128·2% 45·2%
fatigue syndrome (2064·8 to 8078·2) (380·7 to 1726·5) (69·0 to 8459·3)* (41·1 to 149·3)* (38·2 to 6850·0)* (27·3 to 124·6)*
Dengue episode 1849·2 104 771·9 108·7 177·7% 61·1% 126·7% 45·0%
(1117·6 to 2774·7) (63 759·0 to 158 870·0) (56·0 to 189·7) (68·1 to 8513·3)* (42·2 to 140·9)* (37·4 to 6942·1)* (28·0 to 116·7)*
Yellow fever 2·6 97·4 0·1 −53·3% −15·8% −61·1% −22·4%
(0·8 to 7·1) (28·0 to 251·7) (0·0 to 0·2) (−57·7 to −47·9)* (−25·4 to −4·4)* (−64·7 to −56·7)* (−31·4 to −11·4)*
Asymptomatic yellow fever 1·5 54·4 ·· ·· ·· ·· ··
(0·4 to 4·2) (14·0 to 152·9)
Yellow fever episode 1·2 43·0 0·1 −53·3% −15·8% −61·1% −22·4%
(0·3 to 3·0) (12·5 to 115·1) (0·0 to 0·2) (−57·7 to −47·9)* (−25·4 to −4·4)* (−64·7 to −56·7)* (−31·4 to −11·4)*
Rabies 0·5 13·4 0·1 −46·8% −35·4% −56·9% −43·3%
(0·4 to 0·6) (10·9 to 16·2) (0·0 to 0·1) (−57·6 to −36·0)* (−45·7 to −23·8)* (−66·1 to −48·1)* (−52·3 to −32·9)*
Intestinal nematode 894 917·5 ·· 1661·4 −35·8% −30·1% −47·3% −36·3%
infections (836 669·5 to 961 911·6) (960·3 to 2708·6) (−41·3 to −30·1)* (−33·9 to −26·1)* (−51·8 to −42·6)* (−39·8 to −32·7)*
Ascariasis 447 009·0 ·· 603·8 −38·3% −34·2% −48·3% −39·9%
(394 765·2 to 508 585·1) (325·2 to 1037·6) (−47·2 to −28·7)* (−41·2 to −26·8)* (−55·9 to −40·2)* (−46·2 to −33·1)*
Asymptomatic ascariasis 414 347·5 ·· ·· ·· ·· ·· ··
(365 611·9 to 472 277·1)
Ascariasis complications 32 661·5 ·· 603·8 −38·3% −34·2% −48·3% −39·9%
(28 939·0 to 36 737·1) (325·2 to 1037·6) (−47·2 to −28·7)* (−41·2 to −26·8)* (−55·9 to −40·2)* (−46·2 to −33·1)*
Trichuriasis 289 617·7 ·· 212·7 −43·0% −23·1% −53·4% −29·3%
(254 640·5 to 330 724·5) (120·0 to 353·7) (−50·2 to −35·7)* (−29·3 to −15·8)* (−59·4 to −47·5)* (−35·0 to −22·5)*
Asymptomatic 278 887·2 ·· ·· ·· ·· ·· ··
trichuriasis (244 650·6 to 318 878·2)
Trichuriasis complications 10 730·6 ·· 212·7 −43·0% −23·1% −53·4% −29·3%
(9782·7 to 11 693·0) (120·0 to 353·7) (−50·2 to −35·7)* (−29·3 to −15·8)* (−59·4 to −47·5)* (−35·0 to −22·5)*
Hookworm disease 229 217·1 ·· 845·0 −31·6% −28·5% −44·8% −35·2%
(212 538·1 to 246 731·6) (510·0 to 1340·3) (−39·5 to −23·8)* (−34·0 to −22·7)* (−51·3 to −38·5)* (−40·2 to −30·0)*
Asymptomatic 190 730·4 ·· ·· ·· ·· ·· ··
hookworm disease (176 950·0 to 205 624·5)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Anaemia due to 9536·1 ·· 245·9 −41·2% −35·4% −51·7% −41·3%
hookworm disease (8764·4 to 10 362·8) (164·0 to 360·4) (−49·1 to −32·8)* (−41·8 to −28·5)* (−58·1 to −44·7)* (−47·1 to −34·9)*
Hookworm disease 28 950·6 ·· 599·1 −25·8% −25·2% −40·8% −32·2%
complications (26 952·9 to 31 087·4) (334·2 to 993·7) (−33·7 to −17·7)* (−30·2 to −19·5)* (−47·2 to −34·4)* (−36·8 to −27·1)*
Food-borne trematodiases 82 532·4 40 746·0 1870·7 9·4% 8·5% −16·6% −6·2%
(74 596·1 to 91 774·9) (35 650·0 to 46 019·1) (1070·9 to 3149·7) (−9·4 to 31·8) (4·8 to 12·0)* (−30·0 to −0·8)* (−9·1 to −3·5)*
Asymptomatic food- 65 832·6 30 998·0 ·· ·· ·· ·· ··
borne trematodiases (56 442·3 to 75 378·7) (23 711·7 to 37 759·6)
Food-borne trematodiases 16 699·7 9748·1 1870·7 9·4% 8·5% −16·6% −6·2%
complications (11 172·6 to 25 636·1) (5025·4 to 16 377·4) (1070·9 to 3149·7) (−9·4 to 31·8) (4·8 to 12·0)* (−30·0 to −0·8)* (−9·1 to −3·5)*
Leprosy 518·5 48·5 31·5 35·0% −1·3% −5·5% −20·4%
(487·7 to 552·5) (45·8 to 51·4) (21·5 to 44·6) (31·7 to 38·2)* (−3·7 to 1·1) (−7·8 to −3·4)* (−22·4 to −18·5)*
Ebola virus disease ·· ·· ·· ·· −96·8% ·· −97·1%
(−97·5 to −94·7)* (−97·8 to −95·3)*
Ebola cases ·· ·· ·· ·· −97·8% ·· −98·1%
(−97·9 to −97·7)* (−98·1 to −98·0)*
Post-Ebola chronic ·· ·· ·· ·· −96·7% ·· −97·1%
fatigue syndrome (−97·5 to −94·6)* (−97·7 to −95·2)*
Zika virus disease 37·6 2232·2 1·2 ·· ·· ·· ··
(28·2 to 52·0) (1659·6 to 3097·6) (0·8 to 1·8)
Zika virus complications 0·9 0·6 0·5 ·· ·· ·· ··
(0·7 to 1·5) (0·4 to 1·2) (0·3 to 0·8)
Zika virus episode 36·7 2231·6 0·7 ·· ·· ·· ··
(27·3 to 50·9) (1659·1 to 3097·0) (0·4 to 1·1)
Guinea worm disease ·· ·· ·· −99·6% −99·5% −99·7% −99·5%
(−99·6 to (−99·6 to (−99·7 to −99·7)* (−99·7 to −99·3)*
−99·6)* −99·3)*
Moderate pain and ·· ·· ·· −99·6% −99·5% −99·7% −99·5%
limited mobility due to (−99·6 to (−99·6 to (−99·7 to −99·7)* (−99·7 to −99·4)*
guinea worm −99·6)* −99·3)*
Guinea worm disease ·· ·· ·· −99·6% −99·5% −99·7% −99·5%
complications (−99·7 to (−99·6 to (−99·7 to −99·7)* (−99·7 to −99·3)*
−99·6)* −99·2)*
Other neglected tropical 52 797·1 ·· 1531·2 2·2% −5·7% −10·9% −13·3%
diseases (51 667·9 to 54 034·5) (1027·0 to 2201·6) (−1·2 to 5·5) (−9·7 to −1·5)* (−13·7 to −8·0)* (−17·1 to −9·4)*
Acute infection due to ·· ·· 13·3 164·3% 107·6% 135·1% 86·9%
other neglected tropical (6·9 to 23·0) (61·7 to 303·2)* (83·3 to 199·8)* (44·5 to 257·7)* (64·7 to 169·5)*
diseases
Anaemia due to other 52 797·1 ·· 1517·9 1·9% −6·2% −11·1% −13·7%
neglected tropical diseases (51 667·9 to 54 034·5) (1018·7 to 2185·7) (−1·4 to 5·3) (−10·2 to −2·0)* (−14·0 to −8·3)* (−17·6 to −9·8)*
Other infectious diseases 101 451·5 478 720·6 4056·6 5·0% −0·5% −13·3% −10·6%
(97 425·1 to 105 559·6) (450 498·3 to (2835·5 to 5535·8) (2·1 to 7·5)* (−2·9 to 1·6) (−15·3 to −11·5)* (−12·7 to −8·9)*
511 601·6)
Meningitis 10 572·9 5045·4 933·9 10·6% −3·2% −10·3% −12·4%
(8836·7 to 12 552·2) (4435·1 to 5877·8) (653·0 to 1255·1) (8·4 to 13·2)* (−5·9 to −0·3)* (−12·2 to −8·1)* (−14·7 to −9·7)*
Pneumococcal meningitis 3557·0 444·9 325·0 19·9% −24·8% −3·7% −32·1%
(2932·0 to 4337·6) (357·8 to 552·1) (219·2 to 440·0) (16·6 to 23·3)* (−27·4 to −22·1)* (−6·3 to −1·0)* (−34·6 to −29·6)*
Acute pneumococcal 19·9 444·9 2·6 9·7% −28·4% −0·9% −34·1%
meningitis (15·8 to 25·0) (357·8 to 552·1) (1·6 to 3·9) (3·6 to 15·9)* (−34·2 to −22·4)* (−6·0 to 4·7) (−39·8 to −28·4)*
Pneumococcal meningitis 3537·1 ·· 322·4 20·0% −24·7% −3·7% −32·1%
complications (2915·9 to 4314·0) (217·6 to 436·2) (16·7 to 23·4)* (−27·4 to −22·1)* (−6·4 to −1·0)* (−34·5 to −29·5)*
H influenzae type B 924·2 262·3 84·3 −2·7% −48·1% −20·3% −52·5%
meningitis (668·2 to 1229·3) (195·1 to 351·1) (57·6 to 115·4) (−5·7 to 0·5) (−50·4 to −45·8)* (−22·8 to −17·6)* (−54·6 to −50·3)*
Acute H influenzae type B 11·3 262·3 1·5 −9·6% −48·4% −16·3% −51·7%
meningitis (8·4 to 15·2) (195·1 to 351·1) (0·9 to 2·4) (−14·9 to −4·3)* (−54·2 to −42·2)* (−21·4 to −11·4)* (−57·2 to −45·6)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
H influenzae type B 912·9 ·· 82·8 −2·6% −48·1% −20·4% −52·5%
meningitis complications (657·9 to 1216·9) (56·6 to 113·3) (−5·6 to 0·7) (−50·4 to −45·8)* (−23·0 to −17·6)* (−54·6 to −50·2)*
Meningococcal infection 1076·7 402·5 99·0 12·4% −3·2% −9·8% −12·9%
(764·8 to 1424·7) (312·5 to 517·6) (67·5 to 135·4) (9·4 to 15·4)* (−6·4 to −0·1)* (−12·3 to −7·3)* (−15·9 to −10·0)*
Acute meningococcal 18·0 402·5 2·4 5·8% −4·1% −3·6% −12·0%
meningitis (13·9 to 23·1) (312·5 to 517·6) (1·4 to 3·7) (−1·3 to 13·5) (−12·3 to 4·5) (−9·8 to 3·0) (−19·8 to −3·9)*
Meningococcal 1058·6 ·· 96·6 12·6% −3·2% −10·0% −12·9%
meningitis complications (749·6 to 1404·6) (65·7 to 132·1) (9·6 to 15·6)* (−6·3 to −0·1)* (−12·5 to −7·4)* (−15·9 to −10·1)*
Other meningitis 5015·1 3935·7 425·7 5·6% 58·6% −13·3% 43·4%
(3735·5 to 6370·4) (3466·6 to 4569·8) (292·3 to 570·1) (2·9 to 8·6)* (53·4 to 64·1)* (−15·7 to −10·7)* (38·7 to 48·4)*
Other acute bacterial 64·0 1519·8 8·5 −1·8% 54·1% −8·3% 42·9%
meningitis (54·6 to 76·8) (1296·4 to 1836·4) (5·4 to 12·6) (−6·8 to 4·1) (41·2 to 68·0)* (−13·1 to −3·2)* (30·7 to 56·3)*
Acute viral meningitis 109·0 2416·0 14·5 6·8% 5·8% −9·2% −3·9%
(95·5 to 125·5) (2142·8 to 2745·8) (9·3 to 20·8) (3·0 to 10·6)* (0·5 to 11·4)* (−12·4 to −5·9)* (−9·0 to 1·6)
Other bacterial 4842·0 ·· 402·7 5·7% 61·6% −13·6% 46·1%
meningitis complications (3574·3 to 6179·3) (275·3 to 539·5) (2·8 to 9·0)* (56·3 to 67·5)* (−16·2 to −10·8)* (41·1 to 51·4)*
Encephalitis 6724·9 2220·5 524·1 9·0% 6·7% −15·8% −6·2%
(3731·2 to 10 760·4) (2189·1 to 2255·2) (365·5 to 691·3) (6·6 to 11·2)* (4·6 to 8·9)* (−17·5 to −14·1)* (−8·1 to −4·3)*
Acute encephalitis 116·9 2220·5 15·5 14·1% 13·9% −5·2% 1·2%
(115·1 to 118·8) (2189·1 to 2255·2) (10·4 to 22·2) (13·3 to 14·8)* (13·4 to 14·3)* (−5·8 to −4·7)* (0·8 to 1·6)*
Encephalitis complications 6608·0 ·· 508·6 8·8% 6·5% −16·1% −6·5%
(3613·0 to 10 644·0) (355·4 to 672·4) (6·4 to 11·1)* (4·3 to 8·8)* (−17·8 to −14·3)* (−8·4 to −4·5)*
Diphtheria 1·1 14·4 0·1 −76·4% −32·3% −77·6% −36·7%
(0·7 to 1·7) (9·7 to 22·4) (0·0 to 0·1) (−81·7 to −69·1)* (−55·3 to 7·2) (−82·6 to −70·7)* (−58·7 to 1·1)
Whooping cough 1974·5 14 413·5 98·1 −26·1% −8·2% −26·5% −12·9%
(1525·2 to 2490·2) (11 134·0 to 18 178·7) (58·2 to 154·8) (−27·9 to −24·0)* (−10·3 to −6·3)* (−28·4 to −24·5)* (−14·8 to −11·0)*
Tetanus 59·6 79·2 1·7 −59·8% −28·6% −64·3% −36·2%
(56·7 to 62·6) (53·4 to 105·3) (1·1 to 2·5) (−66·6 to (−39·7 to −17·5)* (−70·0 to −57·5)* (−46·2 to −26·1)*
−51·9)*
Severe tetanus 4·4 79·2 0·6 −73·0% −57·0% −75·4% −61·3%
(3·0 to 5·9) (53·4 to 105·3) (0·3 to 0·9) (−77·3 to −66·9)* (−67·1 to −42·6)* (−79·2 to −70·1)* (−70·2 to −48·0)*
Neonatal tetanus 55·2 ·· 1·1 12·2% 8·6% −7·3% −2·0%
complications (52·9 to 57·6) (0·6 to 1·8) (9·5 to 14·1)* (6·6 to 10·3)* (−9·0 to −6·1)* (−3·7 to −0·5)*
Measles 572·3 20 888·3 51·4 −44·0% −46·7% −44·6% −49·7%
(203·7 to 1267·9) (7433·5 to 46 276·7) (17·4 to 118·2) (−47·2 to −41·0)* (−51·4 to −41·5)* (−47·8 to −41·6)* (−54·1 to −44·8)*
Varicella and herpes zoster 6836·5 95 660·6 311·4 38·1% 21·7% 1·8% 1·0%
(6151·0 to 7510·6) (91 657·3 to 99 992·6) (187·5 to 471·2) (34·9 to 41·5)* (19·1 to 24·3)* (0·0 to 3·7)* (−0·6 to 2·5)
Chickenpox 1236·7 64 530·2 7·1 1·4% 5·8% −0·9% 0·1%
(1200·1 to 1273·0) (62 619·2 to 66 422·9) (2·8 to 15·0) (−1·1 to 3·8) (3·3 to 8·1)* (−3·1 to 1·4) (−2·4 to 2·3)
Herpes zoster 5599·7 31 130·4 304·3 39·5% 22·1% 1·9% 1·0%
(4913·3 to 6277·7) (27 271·7 to 35 058·2) (183·4 to 461·1) (36·3 to 42·8)* (19·5 to 24·8)* (0·1 to 3·8)* (−0·6 to 2·6)
Acute hepatitis 31 960·4 340 398·7 511·8 32·1% 7·5% 4·9% −3·8%
(29 698·0 to 34 406·8) (319 758·5 to 362 492·1) (334·5 to 739·0) (21·7 to 42·8)* (−0·8 to 17·2) (−3·5 to 13·5) (−11·0 to 4·7)
Acute hepatitis A 13 087·1 170 132·3 211·2 24·2% 6·8% 5·6% −0·4%
(12 396·2 to 13 831·2) (161 150·2 to 179 805·9) (134·0 to 308·2) (15·6 to 33·9)* (0·2 to 13·5)* (−1·7 to 13·6) (−6·9 to 6·3)
Acute hepatitis B 16 793·7 145 731·0 263·5 42·1% 8·4% 5·5% −6·7%
(14 752·6 to 19 222·1) (128 012·1 to 166 802·5) (169·6 to 398·1) (21·9 to 65·7)* (−6·2 to 26·7) (−9·4 to 22·7) (−18·9 to 8·6)
Acute hepatitis C 587·4 5091·1 8·2 5·7% 3·1% −8·6% −7·1%
(532·0 to 649·7) (4610·8 to 5631·1) (4·0 to 15·8) (0·7 to 10·9)* (−1·3 to 7·5) (−12·4 to −4·9)* (−11·4 to −3·0)*
Acute hepatitis E 1492·1 19 444·3 28·9 20·6% 6·5% −0·4% −1·9%
(1330·2 to 1674·3) (17 332·9 to 21 836·3) (17·9 to 43·5) (10·1 to 32·1)* (−1·8 to 15·7) (−8·6 to 8·9) (−9·6 to 6·2)
Other unspecified infectious 53 643·7 ·· 1624·1 −0·4% −3·5% −16·0% −12·1%
diseases (52 688·5 to 54 671·1) (1084·1 to 2337·5) (−3·3 to 2·5) (−6·7 to −0·2)* (−18·3 to −13·8)* (−15·1 to −9·0)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Guillain-Barré syndrome due 7·4 ·· 2·2 29·2% 18·0% 2·7% 3·1%
to other infectious diseases (5·0 to 10·7) (1·2 to 3·6) (25·3 to 33·5)* (15·5 to 20·6)* (1·1 to 4·3)* (2·0 to 4·2)*
Other infectious diseases ·· ·· 187·2 12·3% 18·0% −11·2% 6·0%
(114·4 to 291·1) (8·1 to 15·9)* (15·7 to 20·2)* (−14·3 to −8·6)* (4·1 to 7·8)*
Anaemia due to other 53 636·3 ·· 1434·7 −1·6% −5·7% −16·5% −13·9%
infectious diseases (52 678·9 to 54 662·5) (967·8 to 2073·7) (−4·7 to 1·4) (−9·1 to −2·2)* (−19·0 to −14·1)* (−17·2 to −10·6)*
Maternal and neonatal 158 835·8 101 962·6 29 894·3 49·5% 22·6% 24·5% 11·3%
disorders (140 427·7 to 179 076·8) (94 726·5 to 109 284·9) (22 429·9 to (44·8 to 54·4)* (16·2 to 29·9)* (20·8 to 28·3)* (5·5 to 18·0)*
38 381·6)
Maternal disorders 8532·0 79 812·2 805·6 0·7% −3·3% −21·9% −12·5%
(7424·5 to 9856·9) (72 665·3 to 87 135·8) (570·1 to 1084·3) (−8·3 to 10·5) (−12·0 to 7·1) (−28·6 to −14·6)* (−20·6 to −3·3)*
Maternal haemorrhage 1659·9 6988·4 60·9 −16·6% −4·5% −32·4% −12·6%
(1538·9 to 1777·6) (5611·4 to 8568·4) (40·9 to 87·1) (−28·5 to −3·5)* (−18·5 to 11·5) (−42·0 to −21·7)* (−25·1 to 2·2)
Maternal haemorrhage 1506·9 ·· 35·5 −20·9% −6·7% −35·8% −14·6%
complications (1412·6 to 1601·5) (23·6 to 51·8) (−28·3 to −13·0)* (−14·7 to 1·1) (−41·7 to −29·6)* (−21·7 to −7·5)*
Maternal haemorrhage 153·0 6988·4 25·5 −9·3% −1·2% −26·6% −9·5%
episode (100·5 to 227·6) (5611·4 to 8568·4) (15·0 to 40·0) (−35·3 to 30·5) (−32·3 to 41·8) (−47·7 to 5·4) (−37·8 to 30·0)
Maternal sepsis and other 2989·5 12 060·9 57·0 −1·7% 5·9% −21·4% −3·0%
pregnancy-related infections (2502·7 to 3623·3) (9668·8 to 14 890·9) (29·3 to 101·3) (−39·7 to 68·6) (−34·4 to 65·1) (−51·3 to 33·9) (−40·4 to 51·3)
Infertility due to 2073·0 113·0 10·4 39·6% 21·8% −0·3% 6·6%
puerperal sepsis (1839·6 to 2335·1) (100·6 to 127·1) (3·9 to 21·8) (36·9 to 42·7)* (19·2 to 24·3)* (−2·2 to 1·7) (4·3 to 8·8)*
Maternal sepsis and other 916·5 11 947·9 46·6 −6·9% 2·9% −24·5% −4·8%
maternal infection episode (511·3 to 1514·1) (9553·3 to 14 781·0) (22·8 to 85·5) (−46·6 to 75·8) (−42·8 to 75·5) (−56·7 to 42·2) (−47·1 to 61·2)
Maternal hypertensive 2849·8 15 830·2 143·1 −6·3% −0·9% −24·7% −9·1%
disorders (1890·6 to 3972·4) (13 530·0 to 18 779·5) (80·7 to 231·8) (−35·5 to 40·3) (−34·3 to 41·0) (−48·6 to 12·5) (−39·6 to 29·3)
Maternal hypertensive 102·0 1600·2 6·7 38·4% 17·9% 9·7% 7·3%
disorder complications (97·7 to 107·0) (1535·3 to 1675·1) (4·1 to 10·2) (31·0 to 46·7)* (10·7 to 24·7)* (3·8 to 16·4)* (0·7 to 13·4)*
Maternal hypertensive 2747·7 14 230·0 136·4 −7·5% −1·7% −25·7% −9·8%
disorder episode (1789·8 to 3869·6) (11 902·3 to 17 192·4) (75·7 to 220·6) (−37·4 to 40·2) (−36·0 to 41·7) (−49·9 to 12·4) (−41·1 to 30·4)
Maternal obstructed labour 1232·6 7915·2 397·6 −0·9% −10·7% −24·9% −20·0%
and uterine rupture (1048·2 to 1449·1) (6032·2 to 10 169·3) (260·5 to 551·0) (−6·0 to 5·2) (−15·8 to −5·0)* (−28·6 to −20·6)* (−24·5 to −14·9)*
Obstructed labour, acute 105·1 7694·5 33·0 −9·9% 0·8% −26·4% −7·0%
event (64·7 to 163·8) (5811·6 to 9959·4) (16·8 to 55·9) (−42·7 to 51·8) (−40·1 to 61·4) (−53·6 to 23·6) (−44·2 to 48·6)
Maternal obstructed 1127·5 220·7 364·6 −0·1% −11·6% −24·8% −21·1%
labour complications (939·1 to 1338·2) (179·2 to 267·7) (238·5 to 506·1) (−4·2 to 4·3) (−15·7 to −7·2)* (−27·7 to −21·6)* (−24·7 to −17·3)*
Maternal abortive outcome 164·2 20 052·1 18·1 2·5% 2·4% −18·0% −5·6%
(109·5 to 234·1) (16 262·0 to 25 281·8) (10·2 to 29·7) (−32·1 to 54·5) (−34·5 to 51·8) (−45·6 to 24·0) (−39·4 to 39·1)
Ectopic pregnancy 138·7 16 965·4 15·1 35·5% 14·6% 6·5% 5·1%
(90·1 to 199·9) (13 647·7 to 20 936·5) (8·3 to 24·0) (−10·4 to 115·0) (−26·3 to 72·1) (−29·1 to 68·3) (−32·4 to 58·5)
Other maternal disorders ·· ·· 113·8 45·4% 20·1% 12·9% 9·0%
(80·5 to 154·3) (32·0 to 60·0)* (8·9 to 33·5)* (3·0 to 23·8)* (−1·0 to 21·2)
Neonatal disorders 150 455·9 22 150·4 29 088·7 52·1% 23·5% 27·0% 12·1%
(131 734·1 to 170 851·4) (20 975·1 to 23 700·8) (21 771·2 to (47·2 to 57·4)* (16·8 to 31·2)* (22·9 to 31·3)* (6·2 to 19·2)*
37 499·1)
Neonatal preterm birth 92 585·6 17 416·9 13 156·9 46·0% 26·1% 22·2% 14·8%
(81 049·6 to 106 597·3) (17 182·7 to 17 646·4) (9307·3 to 17 833·1) (39·6 to 52·0)* (10·6 to 41·4)* (17·0 to 27·1)* (0·7 to 28·6)*
Preterm birth 67 508·3 ·· 12 537·7 48·4% 27·3% 24·7% 16·0%
complications (56 539·6 to 81 115·5) (8824·7 to 17 161·8) (41·1 to 55·5)* (10·6 to 43·7)* (18·7 to 30·8)* (0·8 to 30·8)*
Retinopathy of 11 361·8 ·· 619·2 14·4% 6·1% −8·6% −5·9%
prematurity (8979·6 to 13 871·7) (415·3 to 861·4) (10·0 to 18·7)* (2·4 to 10·3)* (−12·3 to −5·0)* (−9·5 to −2·0)*
Uncomplicated preterm 13 715·6 17 416·9 ·· ·· ·· ·· ··
birth (12 775·0 to 14 383·3) (17 182·7 to 17 646·4)
Neonatal encephalopathy 53 823·7 2753·4 9703·5 69·8% 23·0% 39·5% 11·1%
due to birth asphyxia and (39 817·7 to 70 951·7) (1840·4 to 4017·0) (5872·1 to 15 081·3) (57·8 to 84·9)* (19·3 to 27·6)* (30·0 to 51·5)* (7·7 to 14·9)*
trauma


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Neonatal sepsis and other 14 268·5 1326·7 4171·9 44·7% 19·5% 17·5% 7·5%
neonatal infections (8908·0 to 21 573·1) (792·7 to 2284·9) (2230·5 to 7009·0) (39·1 to 50·6)* (15·9 to 22·5)* (13·0 to 22·1)* (4·3 to 10·1)*
Neonatal sepsis and other 13 944·6 996·6 4171·9 44·7% 19·5% 17·5% 7·5%
neonatal infection (8561·4 to 21 248·8) (472·4 to 1951·3) (2230·5 to 7009·0) (39·1 to 50·6)* (15·9 to 22·5)* (13·0 to 22·1)* (4·3 to 10·1)*
complications
Neonatal sepsis and other 323·9 330·1 ·· ·· ·· ·· ··
neonatal infection (254·4 to 405·5) (259·0 to 413·2)
episode
Haemolytic disease and 2355·4 653·3 877·7 37·1% 20·2% 14·8% 9·3%
other neonatal jaundice (2032·4 to 2684·1) (269·5 to 1211·6) (679·2 to 1090·3) (33·2 to 40·9)* (16·6 to 23·3)* (11·4 to 17·9)* (6·0 to 12·2)*
Other neonatal disorders ·· ·· 1178·7 35·3% 16·0% 35·6% 9·7%
(893·2 to 1519·2) (31·1 to 39·6)* (9·2 to 23·8)* (31·4 to 39·9)* (3·3 to 17·2)*
Nutritional deficiencies 1 862 030·8 1 186 745·8 42 376·2 −8·3% −7·8% −20·9% −16·1%
(1 806 258·9 to (1 089 728·9 to (28 774·0 to (−10·4 to −6·2)* (−10·6 to −4·9)* (−22·7 to −19·3)* (−18·5 to −13·4)*
1 921 493·5) 1 283 530·0) 61 009·9)
Protein-energy malnutrition 96 454·6 79 726·7 1798·0 −19·5% −3·4% −22·0% −10·1%
(93 495·9 to 99 611·1) (76 183·7 to 83 392·8) (1167·7 to 2545·0) (−23·4 to −15·5)* (−6·3 to −0·7)* (−26·0 to −18·1)* (−12·8 to −7·6)*
Iodine deficiency 116 021·9 3027·9 2057·7 −33·6% −6·9% −46·4% −17·4%
(104 300·5 to 128 878·3) (2734·2 to 3363·7) (1247·3 to 3255·6) (−38·2 to −27·8)* (−10·1 to −4·3)* (−50·2 to −41·9)* (−20·1 to −14·9)*
Visible goitre without 113 393·1 3027·9 1208·8 −41·9% −6·1% −53·3% −17·4%
symptoms (101 868·1 to 126 335·9) (2734·2 to 3363·7) (590·5 to 2248·6) (−45·1 to −38·3)* (−8·2 to −4·4)* (−55·6 to −50·6)* (−19·2 to −15·9)*
Visible goitre with 2628·8 ·· 848·9 −17·0% −8·1% −32·7% −17·3%
complications (1500·7 to 3684·3) (445·5 to 1286·3) (−22·5 to −11·1)* (−15·8 to −3·1)* (−37·2 to −27·6)* (−24·2 to −12·8)*
Vitamin A deficiency 818 420·2 1 103 991·2 8313·0 −19·7% −17·3% −23·0% −22·3%
(748 849·9 to 892 688·1) (1 007 169·1 to (5398·6 to 12 150·6) (−22·9 to −16·7)* (−20·8 to −13·6)* (−26·0 to −20·2)* (−25·7 to −18·8)*
1 199 987·2)
Asymptomatic vitamin A 600 048·0 1 103 991·2 ·· ·· ·· ·· ··
deficiency (547 539·5 to 655 650·3) (1 007 169·1 to
1 199 987·2)
Vitamin A deficiency 5403·4 ·· 304·0 23·8% 13·4% 8·8% 3·7%
complications (4329·4 to 6754·9) (195·6 to 442·0) (19·4 to 28·3)* (9·9 to 17·1)* (5·3 to 12·1)* (0·6 to 7·1)*
Vitamin A deficiency with 212 971·7 ·· 8009·0 −20·5% −18·1% −23·6% −23·0%
anaemia (189 376·4 to 240 436·1) (5196·4 to 11 716·1) (−23·7 to −17·4)* (−21·8 to −14·3)* (−26·7 to −20·7)* (−26·5 to −19·5)*
Dietary iron deficiency 1 136 043·5 ·· 30 013·9 −0·2% −5·2% −17·4% −14·3%
(1 117 204·2 to 1 156 043·7) (20 323·3 to (−2·8 to 2·2) (−8·3 to −1·9)* (−19·4 to −15·5)* (−17·2 to −11·4)*
43 628·0)
Other nutritional deficiencies ·· ·· 193·6 −13·7% 2·2% −25·8% −9·6%
(125·3 to 272·6) (−20·8 to −7·2)* (−2·6 to 6·2) (−32·2 to −19·9)* (−13·9 to −6·2)*
Non-communicable diseases 7 011 916·8 10 813 562·6 678 294·4 35·0% 19·3% −1·3% 0·1%
(6 965 421·4 to (10 375 088·4 to (510 467·3 to (34·4 to 35·7)* (18·8 to 19·9)* (−1·7 to −0·9)* (−0·3 to 0·5)
7 057 358·0) 11 286 148·0) 875 605·3)
Neoplasms 100 482·9 24 361·6 7775·2 59·3% 40·6% 8·5% 9·7%
(98 189·8 to 102 850·5) (21 911·3 to 27 310·3) (5747·9 to (55·6 to 63·3)* (38·3 to 43·2)* (6·0 to 11·2)* (7·6 to 12·0)*
10 028·9)
Lip and oral cavity cancer 1631·9 389·8 163·3 49·6% 39·8% 1·1% 9·2%
(1570·3 to 1691·6) (374·5 to 404·4) (120·3 to 212·3) (44·6 to 54·6)* (34·0 to 45·1)* (−2·3 to 4·4) (4·7 to 13·4)*
Diagnosis and primary 95·7 389·8 26·6 50·8% 40·1% 2·2% 9·8%
therapy phase of mouth (92·1 to 99·1) (374·5 to 404·4) (18·0 to 36·6) (44·8 to 57·1)* (34·2 to 46·3)* (−1·8 to 6·4) (5·2 to 14·5)*
cancer
Controlled phase of mouth 1364·1 ·· 62·4 51·8% 41·0% 3·6% 11·2%
cancer (1312·8 to 1414·1) (40·8 to 89·4) (46·5 to 56·9)* (35·3 to 46·7)* (0·0 to 6·8)* (6·7 to 15·6)*
Metastatic phase of mouth 149·4 ·· 62·1 47·5% 38·5% −1·0% 7·4%
cancer (143·4 to 154·9) (42·6 to 81·2) (41·0 to 54·6)* (31·9 to 45·2)* (−5·3 to 3·6) (2·3 to 12·5)*
Terminal phase of mouth 22·7 ·· 12·2 47·4% 39·5% −1·4% 7·8%


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Nasopharynx cancer 508·7 109·8 52·3 6·6% 20·3% −24·7% −1·6%
(480·9 to 539·0) (104·4 to 115·6) (37·8 to 69·6) (−1·2 to 14·3) (13·7 to 28·1)* (−29·8 to −19·7)* (−7·0 to 4·5)
Diagnosis and primary 29·1 109·8 8·3 7·7% 20·3% −23·4% −0·7%
therapy phase of (27·5 to 30·9) (104·4 to 115·6) (5·6 to 11·7) (−0·9 to 17·5) (12·0 to 29·9)* (−29·4 to −16·9)* (−7·4 to 6·9)
nasopharynx cancer
Controlled phase of 427·7 ·· 20·3 6·7% 19·7% −23·7% −0·7%
nasopharynx cancer (403·8 to 453·3) (13·1 to 29·9) (−1·8 to 15·3) (12·1 to 28·1)* (−29·5 to −18·0)* (−6·9 to 6·0)
Metastatic phase of 46·2 ·· 20·6 6·5% 20·9% −25·6% −2·6%
Terminal phase of 5·7 ·· 3·1 3·5% 20·7% −27·8% −3·5%
Other pharynx cancer 440·8 179·3 59·2 61·7% 44·3% 10·1% 11·7%
(399·7 to 462·4) (160·3 to 188·6) (42·3 to 77·6) (54·3 to 70·4)* (35·0 to 51·2)* (5·1 to 15·8)* (4·4 to 16·9)*
therapy phase of other (22·3 to 25·7) (160·3 to 188·6) (4·7 to 9·8) (62·7 to 77·5)* (38·2 to 53·0)* (10·8 to 20·8)* (7·0 to 18·4)*
pharynx cancer
Controlled phase of other 334·1 ·· 15·5 72·0% 46·5% 17·5% 13·8%
pharynx cancer (304·3 to 350·1) (10·0 to 22·9) (63·3 to 81·8)* (37·3 to 54·0)* (11·7 to 24·1)* (6·6 to 19·6)*
Metastatic phase of other 69·6 ·· 29·9 56·4% 42·7% 6·4% 10·3%
Terminal phase of other 12·6 ·· 6·8 56·7% 44·2% 6·6% 11·3%
Oesophageal cancer 806·3 472·5 130·3 34·6% 19·0% −9·1% −9·1%
(782·1 to 829·8) (459·5 to 485·3) (94·5 to 166·4) (29·1 to 40·2)* (14·5 to 23·9)* (−12·7 to −5·3)* (−12·6 to −5·4)*
therapy phase of (65·0 to 69·0) (459·5 to 485·3) (12·4 to 25·4) (37·3 to 53·9)* (17·5 to 31·3)* (−6·7 to 4·5) (−9·9 to 0·8)
oesophageal cancer
Controlled phase of 535·4 ·· 24·6 52·6% 26·1% 4·7% −2·8%
oesophageal cancer (518·8 to 552·0) (16·0 to 35·8) (45·9 to 58·7)* (20·9 to 31·5)* (0·1 to 8·8)* (−6·8 to 1·2)
oesophageal cancer (162·9 to 171·9) (47·0 to 89·1) (22·5 to 35·2)* (10·5 to 21·8)* (−17·4 to −8·9)* (−15·8 to −7·3)*
oesophageal cancer (35·4 to 37·4) (13·4 to 24·3) (21·9 to 36·6)* (10·7 to 23·1)* (−17·9 to −8·2)* (−15·7 to −6·3)*
Stomach cancer 2823·2 1220·7 348·8 17·6% 32·7% −20·8% 1·2%
(2740·2 to 2914·9) (1189·0 to 1254·6) (255·9 to 448·5) (14·4 to 20·9)* (28·1 to 37·7)* (−23·0 to −18·6)* (−2·3 to 5·0)
Diagnosis and primary 268·1 1220·7 70·1 22·1% 39·7% −17·8% 6·6%
therapy phase of stomach (260·2 to 276·6) (1189·0 to 1254·6) (47·9 to 95·2) (17·7 to 26·4)* (34·3 to 45·6)* (−20·7 to −15·0)* (2·5 to 11·1)*
cancer
Controlled phase of 2122·2 ·· 96·9 31·4% 54·0% −11·0% 18·1%
stomach cancer (2057·1 to 2193·0) (62·7 to 140·7) (28·3 to 34·8)* (48·8 to 59·4)* (−13·1 to −8·8)* (14·2 to 22·2)*
stomach cancer (335·7 to 353·8) (95·8 to 178·7) (7·5 to 15·1)* (16·9 to 26·2)* (−27·7 to −22·7)* (−10·8 to −3·9)*
Terminal phase of stomach 88·7 ·· 44·6 11·8% 21·1% −24·8% −7·7%
cancer (86·5 to 91·2) (31·3 to 56·9) (7·7 to 15·9)* (16·3 to 26·8)* (−27·6 to −22·0)* (−11·4 to −3·5)*
Colon and rectum cancer 9352·3 1833·5 877·6 70·2% 39·8% 12·3% 6·0%
(9143·0 to 9558·6) (1791·9 to 1873·5) (650·2 to 1133·2) (65·4 to 74·2)* (35·9 to 43·6)* (9·3 to 15·1)* (3·1 to 9·0)*
therapy phase of colon and (391·8 to 410·2) (1791·9 to 1873·5) (70·4 to 139·0) (72·3 to 84·4)* (38·3 to 48·8)* (14·7 to 22·5)* (5·4 to 13·4)*
rectum cancers
Controlled phase of colon 7946·7 ·· 453·5 83·2% 42·8% 22·9% 9·2%
and rectum cancers (7764·5 to 8129·2) (304·5 to 637·7) (79·5 to 86·7)* (38·9 to 47·0)* (20·6 to 25·1)* (6·3 to 12·3)*
Metastatic phase of colon 653·8 ·· 253·1 54·5% 35·5% 0·6% 1·8%
and rectum cancers (639·1 to 667·7) (176·5 to 327·7) (49·5 to 59·3)* (31·2 to 40·2)* (−2·4 to 3·5) (−1·4 to 5·2)
Terminal phase of colon 92·9 ·· 45·9 48·8% 33·5% −2·9% 0·2%
and rectum cancers (90·8 to 94·9) (32·6 to 57·9) (42·5 to 54·6)* (28·3 to 38·2)* (−6·8 to 0·7) (−3·7 to 3·8)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Stoma from colon and 257·8 ·· 22·1 52·3% 28·3% −3·5% −5·2%
rectum cancers, beyond (249·3 to 266·6) (15·3 to 30·0) (47·4 to 57·0)* (25·1 to 31·6)* (−6·5 to −0·6)* (−7·6 to −2·9)*
10 years
Liver cancer 803·4 953·1 229·5 52·2% 39·8% 4·4% 8·1%
(753·1 to 856·7) (916·5 to 997·0) (163·9 to 301·7) (44·8 to 60·5)* (34·2 to 47·3)* (−0·6 to 9·9) (3·8 to 13·7)*
Liver cancer due to 661·2 404·0 98·1 42·1% 38·1% −1·5% 8·6%
hepatitis B (617·3 to 713·0) (378·3 to 434·1) (69·9 to 129·6) (34·2 to 52·6)* (30·2 to 48·7)* (−7·0 to 5·6) (2·5 to 17·0)*
therapy phase of liver (91·6 to 105·1) (378·3 to 434·1) (18·0 to 37·2) (29·7 to 53·4)* (24·8 to 48·0)* (−9·9 to 6·5) (−1·6 to 16·5)
cancer due to hepatitis B
Controlled phase of liver 453·6 ·· 21·3 61·5% 70·3% 12·0% 35·0%
cancer due to hepatitis B (422·8 to 490·7) (13·7 to 31·5) (50·8 to 75·1)* (58·3 to 84·7)* (4·8 to 21·1)* (25·4 to 46·4)*
Metastatic phase of liver 78·5 ·· 33·5 37·4% 29·1% −4·7% 1·5%
cancer due to hepatitis B (73·5 to 84·4) (22·9 to 44·7) (27·3 to 50·4)* (19·7 to 40·9)* (−11·8 to 4·0) (−6·0 to 10·7)
Terminal phase of liver 31·3 ·· 16·7 37·9% 29·3% −4·4% 1·5%
cancer due to hepatitis B (29·3 to 33·6) (11·5 to 21·7) (31·2 to 47·0)* (22·3 to 39·6)* (−9·0 to 1·7) (−4·0 to 9·5)
Liver cancer due to 366·5 257·9 60·6 62·2% 38·8% 9·7% 4·9%
hepatitis C (341·7 to 391·6) (241·3 to 274·5) (43·0 to 79·7) (54·8 to 68·9)* (34·3 to 44·5)* (4·6 to 14·2)* (1·5 to 9·2)*
therapy phase of liver (56·9 to 64·7) (241·3 to 274·5) (11·3 to 23·4) (53·2 to 68·2)* (31·9 to 43·9)* (3·5 to 13·5)* (−0·3 to 8·7)
cancer due to hepatitis C
cancer due to hepatitis C (217·9 to 250·9) (6·9 to 15·9) (72·8 to 92·3)* (48·6 to 65·8)* (19·4 to 32·6)* (13·6 to 26·7)*
Metastatic phase of liver 51·0 ·· 22·1 57·6% 34·4% 6·2% 1·4%
cancer due to hepatitis C (47·7 to 54·3) (14·9 to 29·5) (49·8 to 64·5)* (29·1 to 40·1)* (1·0 to 10·8)* (−2·6 to 5·7)
Terminal phase of liver 20·3 ·· 10·9 58·4% 34·7% 6·7% 1·5%
cancer due to hepatitis C (19·0 to 21·6) (7·6 to 14·1) (51·0 to 64·7)* (30·9 to 39·7)* (1·8 to 10·7)* (−1·4 to 5·2)
Liver cancer due to alcohol 206·3 143·9 34·7 62·6% 39·4% 9·6% 7·2%
use (180·7 to 239·9) (127·2 to 165·0) (24·8 to 47·1) (52·2 to 70·8)* (33·7 to 46·1)* (2·7 to 15·0)* (2·9 to 12·1)*
therapy phase of liver (30·0 to 39·1) (127·2 to 165·0) (6·4 to 13·9) (50·9 to 69·6)* (32·0 to 45·2)* (1·7 to 14·1)* (1·7 to 11·4)*
cancer due to alcohol use
cancer due to alcohol use (115·1 to 155·3) (3·8 to 9·2) (74·5 to 101·3)* (45·5 to 65·6)* (19·5 to 37·8)* (13·1 to 28·5)*
cancer due to alcohol use (25·2 to 32·6) (8·6 to 17·4) (47·4 to 65·0)* (29·9 to 41·7)* (−0·7 to 10·8) (−0·2 to 8·5)
cancer due to alcohol use (10·0 to 13·0) (4·2 to 8·1) (47·4 to 65·1)* (30·3 to 41·2)* (−0·8 to 10·8) (0·2 to 8·2)*
Liver cancer due to NASH 97·4 72·2 17·5 74·4% 52·5% 18·2% 16·1%
(86·8 to 108·0) (64·6 to 79·9) (12·3 to 23·1) (63·9 to 83·0)* (47·5 to 58·9)* (11·2 to 23·6)* (12·4 to 20·9)*
therapy phase of liver (15·1 to 18·6) (64·6 to 79·9) (3·2 to 6·7) (62·6 to 81·8)* (46·5 to 57·5)* (10·3 to 22·7)* (11·6 to 19·8)*
cancer due to NASH
cancer due to NASH (53·5 to 67·4) (1·8 to 4·4) (82·0 to 103·9)* (66·7 to 85·7)* (26·1 to 40·9)* (28·9 to 43·7)*
Liver cancer due to other 114·8 75·1 18·6 43·9% 42·3% −0·3% 11·0%
causes (102·2 to 128·7) (67·5 to 83·3) (13·2 to 25·1) (36·4 to 52·0)* (36·1 to 50·4)* (−5·4 to 5·0) (6·5 to 17·2)*
therapy phase of liver (16·1 to 20·0) (67·5 to 83·3) (3·5 to 7·3) (35·2 to 50·5)* (34·9 to 47·9)* (−6·0 to 4·0) (5·4 to 15·3)*
cancer due to other causes
cancer due to other causes (67·5 to 85·8) (2·3 to 5·5) (51·7 to 72·7)* (56·9 to 81·0)* (5·8 to 20·1)* (23·7 to 42·5)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Metastatic phase of liver 14·7 ·· 6·6 40·0% 35·3% −3·1% 5·4%
cancer due to other causes (13·2 to 16·3) (4·5 to 9·0) (32·7 to 47·7)* (30·0 to 42·2)* (−7·8 to 2·0) (1·4 to 10·6)*
Terminal phase of liver 5·8 ·· 3·2 40·0% 35·3% −3·1% 5·4%
cancer due to other causes (5·3 to 6·5) (2·2 to 4·1) (32·7 to 47·7)* (30·0 to 42·2)* (−7·8 to 2·0) (1·4 to 10·6)*
Gallbladder and biliary tract 235·9 210·9 49·1 33·4% 34·6% −12·1% 1·4%
cancer (209·6 to 252·6) (186·1 to 225·4) (34·4 to 64·3) (23·2 to 38·9)* (28·1 to 41·4)* (−18·8 to −8·5)* (−3·7 to 6·8)
therapy phase of gallbladder (29·9 to 35·9) (186·1 to 225·4) (6·2 to 12·9) (24·3 to 39·7)* (28·5 to 42·6)* (−18·1 to −7·9)* (−3·3 to 7·8)
and biliary tract cancer
Controlled phase of 126·7 ·· 5·8 36·9% 53·1% −8·1% 17·5%
gallbladder and biliary tract (113·2 to 136·4) (3·7 to 8·5) (28·6 to 44·3)* (42·0 to 64·3)* (−13·8 to −3·1)* (8·9 to 26·4)*
cancer
gallbladder and biliary tract (51·7 to 62·7) (16·8 to 33·4) (21·7 to 39·8)* (25·3 to 38·3)* (−20·0 to −8·0)* (−6·1 to 4·3)
cancer
gallbladder and biliary tract (14·9 to 18·1) (6·2 to 11·6) (21·9 to 37·2)* (25·4 to 37·6)* (−20·0 to −9·8)* (−6·0 to 3·6)
cancer
Pancreatic cancer 380·6 447·7 91·9 65·8% 38·5% 9·8% 4·7%
(372·7 to 388·4) (438·6 to 456·3) (64·7 to 119·3) (62·2 to 69·6)* (34·8 to 42·2)* (7·3 to 12·4)* (1·8 to 7·6)*
therapy phase of pancreatic (97·0 to 101·0) (438·6 to 456·3) (18·1 to 36·2) (60·1 to 70·8)* (33·2 to 43·5)* (6·0 to 13·2)* (0·6 to 8·4)*
cancer
Controlled phase of 151·7 ·· 7·1 102·1% 35·1% 37·5% 5·1%
pancreatic cancer (148·4 to 155·0) (4·6 to 10·3) (96·0 to 109·5)* (30·2 to 40·4)* (33·3 to 42·6)* (1·4 to 9·2)*
Metastatic phase of 93·2 ·· 38·9 62·5% 39·1% 7·7% 4·8%
Terminal phase of 36·7 ·· 19·4 62·1% 38·6% 6·6% 4·4%
Larynx cancer 1094·9 210·6 109·4 25·1% 34·2% −14·9% 2·8%
(1074·7 to 1118·4) (206·4 to 215·5) (79·7 to 142·5) (21·7 to 28·5)* (30·6 to 37·9)* (−17·2 to −12·6)* (0·0 to 5·6)*
therapy phase of larynx (64·1 to 66·8) (206·4 to 215·5) (12·3 to 24·9) (22·0 to 33·4)* (32·8 to 43·5)* (−17·0 to −9·1)* (1·7 to 9·9)*
cancer
Controlled phase of larynx 882·3 ·· 48·7 28·2% 36·5% −12·3% 4·9%
cancer (864·9 to 902·3) (32·0 to 70·1) (24·5 to 31·8)* (32·5 to 40·5)* (−14·7 to −9·8)* (1·9 to 8·0)*
Metastatic phase of larynx 79·7 ·· 33·8 19·9% 30·8% −18·8% −0·1%
cancer (78·1 to 81·6) (23·2 to 44·7) (14·9 to 24·9)* (25·3 to 36·1)* (−22·2 to −15·5)* (−4·3 to 4·0)
Terminal phase of larynx 11·3 ·· 6·1 16·3% 28·2% −21·3% −2·2%
Laryngectomy from larynx 56·3 ·· 2·7 48·5% 25·6% −0·8% −4·5%
cancer, beyond 10 years (54·4 to 58·2) (1·7 to 4·1) (43·6 to 53·7)* (21·0 to 30·3)* (−4·3 to 2·7) (−8·0 to −0·9)*
Tracheal, bronchus, and lung 3343·1 2163·1 537·1 51·6% 41·0% 2·9% 7·2%
cancer (3267·9 to 3422·5) (2117·0 to 2212·9) (393·6 to 677·2) (47·5 to 55·5)* (36·8 to 45·4)* (0·1 to 5·5)* (3·9 to 10·4)*
therapy phase of tracheal, (214·6 to 224·8) (2117·0 to 2212·9) (39·1 to 77·4) (58·4 to 69·9)* (45·1 to 57·5)* (7·3 to 15·2)* (10·3 to 19·7)*
bronchus, and lung cancer
tracheal, bronchus, and (2137·3 to 2241·4) (64·4 to 144·3) (83·3 to 91·7)* (61·2 to 70·5)* (25·1 to 30·7)* (22·9 to 30·0)*
lung cancer
Metastatic phase of 765·7 ·· 299·0 44·3% 34·5% −2·0% 2·2%
tracheal, bronchus, and (749·5 to 783·3) (208·3 to 387·8) (40·1 to 48·2)* (30·1 to 38·7)* (−4·8 to 0·5) (−1·1 to 5·3)
lung cancer
Terminal phase of tracheal, 169·8 ·· 81·8 44·3% 34·0% −2·2% 1·8%
bronchus, and lung cancer (166·2 to 173·7) (58·1 to 103·2) (38·9 to 49·6)* (28·8 to 39·6)* (−5·7 to 1·3) (−2·1 to 6·0)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Malignant skin melanoma 2324·4 308·7 140·9 104·3% 32·3% 41·3% 4·9%
(1794·8 to 2796·2) (237·6 to 365·9) (90·8 to 201·6) (82·1 to 111·6)* (27·0 to 36·9)* (24·4 to 46·9)* (0·9 to 8·6)*
therapy phase of malignant (49·0 to 76·8) (237·6 to 365·9) (11·0 to 25·2) (89·4 to 118·3)* (26·1 to 38·8)* (30·5 to 52·6)* (0·5 to 10·6)*
skin melanoma
malignant skin melanoma (1709·0 to 2662·4) (59·9 to 154·2) (93·9 to 121·4)* (27·7 to 37·9)* (34·9 to 55·4)* (2·3 to 10·7)*
Metastatic phase of 44·3 ·· 18·4 68·4% 29·5% 12·5% −1·6%
malignant skin melanoma (32·7 to 49·6) (11·3 to 25·1) (40·0 to 80·0)* (22·6 to 35·5)* (−7·3 to 20·9) (−6·9 to 3·2)
Terminal phase of 7·3 ·· 3·9 64·2% 28·7% 9·0% −2·6%
malignant skin melanoma (5·4 to 8·2) (2·4 to 5·2) (37·2 to 73·7)* (21·6 to 33·9)* (−9·7 to 15·6) (−7·8 to 1·3)
Non-melanoma skin cancer 2537·1 7663·6 90·2 211·2% 32·7% 96·8% −2·0%
(1666·4 to 3696·8) (5251·1 to 10 570·3) (49·5 to 149·0) (142·3 to 305·0)* (25·3 to 40·0)* (46·7 to 162·7)* (−7·7 to 3·9)
Non-melanoma skin cancer 2158·9 1778·8 87·7 221·7% 32·8% 102·5% −2·0%
(squamous-cell carcinoma) (1294·8 to 3255·8) (1068·8 to 2620·9) (46·9 to 146·3) (148·5 to 334·5)* (25·0 to 40·0)* (47·3 to 180·3)* (−7·8 to 4·0)
Non-melanoma skin cancer 596·8 5884·8 2·5 44·5% 30·8% −3·8% −1·0%
(basal-cell carcinoma) (325·9 to 947·0) (3702·9 to 8742·9) (0·9 to 5·2) (20·3 to 76·5)* (23·1 to 37·0)* (−21·1 to 18·1) (−6·4 to 3·2)
Breast cancer 16 697·3 1960·7 1307·9 67·7% 33·8% 11·7% 4·5%
(16 178·9 to 17 171·7) (1891·4 to 2023·2) (932·0 to 1769·3) (60·6 to 72·7)* (29·0 to 37·7)* (7·1 to 15·0)* (0·7 to 7·5)*
therapy phase of breast (401·4 to 430·2) (1891·4 to 2023·2) (75·1 to 146·7) (61·6 to 79·5)* (29·4 to 42·2)* (9·0 to 20·4)* (2·2 to 11·9)*
cancer
Controlled phase of breast 13 532·2 ·· 843·4 74·5% 34·4% 17·7% 6·0%
cancer (13 027·8 to 13 977·4) (538·9 to 1218·3) (66·8 to 79·7)* (29·3 to 38·7)* (12·9 to 21·0)* (2·1 to 9·3)*
Metastatic phase of breast 676·3 ·· 263·8 57·5% 33·4% 2·8% 2·3%
cancer (654·5 to 697·0) (183·5 to 341·1) (49·2 to 64·5)* (28·0 to 38·2)* (−2·1 to 7·0) (−1·8 to 5·8)
Terminal phase of breast 52·0 ·· 26·9 49·6% 31·4% −2·1% 0·5%
Mastectomy from breast 2020·3 ·· 66·0 38·5% 25·8% −9·5% −6·2%
cancer, beyond 10 years (1957·2 to 2080·1) (38·5 to 102·5) (35·8 to 41·3)* (23·9 to 27·7)* (−11·2 to −7·8)* (−7·5 to −4·7)*
Cervical cancer 3657·9 601·2 288·1 24·2% 18·9% −14·2% −1·7%
(3364·6 to 3803·1) (554·5 to 625·4) (205·6 to 381·5) (12·3 to 32·3)* (12·6 to 23·2)* (−22·3 to −8·7)* (−6·8 to 1·8)
therapy phase of cervical (172·7 to 195·1) (554·5 to 625·4) (34·5 to 70·5) (13·6 to 35·9)* (12·2 to 25·5)* (−21·1 to −6·0)* (−6·7 to 4·2)
cancer
Controlled phase of cervical 3275·4 ·· 151·8 25·7% 19·7% −12·4% 0·1%
Metastatic phase of cervical 171·3 ·· 72·2 20·9% 17·4% −17·6% −5·1%
Terminal phase of cervical 23·6 ·· 12·8 17·5% 17·4% −20·4% −6·4%
Uterine cancer 3084·6 406·8 210·9 65·8% 36·5% 11·0% 4·9%
(3005·7 to 3171·3) (396·7 to 418·0) (151·5 to 279·7) (60·6 to 71·6)* (32·7 to 41·1)* (7·5 to 14·9)* (1·9 to 8·2)*
therapy phase of uterine (138·2 to 145·8) (396·7 to 418·0) (25·9 to 51·1) (60·6 to 78·2)* (30·9 to 44·1)* (7·8 to 19·7)* (1·0 to 10·9)*
cancer
Controlled phase of uterine 2838·0 ·· 129·3 72·5% 38·3% 16·6% 6·9%
Metastatic phase of uterine 94·9 ·· 38·8 48·4% 31·1% −2·3% −1·0%
Terminal phase of uterine 9·9 ·· 5·3 42·2% 29·0% −6·6% −3·1%
Ovarian cancer 1353·0 286·1 176·1 48·9% 27·7% 1·6% 2·2%
(1313·7 to 1401·1) (278·1 to 295·3) (127·9 to 224·2) (42·2 to 56·6)* (22·9 to 32·9)* (−2·6 to 6·5) (−1·6 to 6·4)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
therapy phase of ovarian (46·7 to 49·8) (278·1 to 295·3) (9·3 to 19·2) (45·6 to 58·8)* (23·9 to 33·0)* (0·5 to 8·9)* (0·1 to 7·4)*
cancer
Controlled phase of ovarian 1027·2 ·· 47·3 52·7% 28·6% 5·8% 4·5%
Metastatic phase of ovarian 261·4 ·· 106·2 47·4% 27·2% 0·1% 1·2%
Terminal phase of ovarian 16·3 ·· 8·8 42·6% 29·0% −4·6% −0·1%
Prostate cancer 9901·9 1334·3 843·2 97·5% 41·0% 27·7% 5·6%
(8810·8 to 12 762·0) (1170·9 to 1697·9) (614·4 to 1146·4) (87·3 to 125·6)* (36·3 to 50·9)* (20·5 to 46·5)* (2·1 to 13·2)*
therapy phase of prostate (303·1 to 446·1) (1170·9 to 1697·9) (57·9 to 121·6) (103·5 to 149·5)* (37·3 to 56·3)* (34·4 to 65·2)* (3·6 to 17·9)*
cancer
prostate cancer (7481·1 to 11 011·9) (309·6 to 698·6) (113·6 to 156·9)* (38·4 to 54·7)* (42·7 to 72·3)* (4·5 to 17·1)*
prostate cancer (568·1 to 817·9) (168·2 to 321·2) (56·2 to 86·0)* (31·6 to 44·7)* (−1·5 to 17·2) (−2·4 to 7·5)
Terminal phase of prostate 39·7 ·· 18·5 57·9% 35·1% −0·7% −0·5%
Impotence and incontinence 421·9 ·· 18·1 61·8% 35·0% 0·5% −1·6%
after 10-year survival from (411·4 to 432·6) (12·6 to 25·0) (57·7 to 66·2)* (31·2 to 38·9)* (−1·9 to 3·1) (−4·2 to 1·1)
prostate cancer
Testicular cancer 578·0 71·3 36·2 51·2% 23·8% 14·7% 9·0%
(556·4 to 603·6) (68·8 to 74·4) (24·8 to 49·6) (44·3 to 58·7)* (18·3 to 29·5)* (9·4 to 20·4)* (4·1 to 14·1)*
therapy phase of testicular (18·2 to 19·7) (68·8 to 74·4) (3·6 to 7·5) (48·5 to 62·3)* (19·2 to 30·8)* (13·3 to 23·5)* (5·4 to 15·6)*
cancer
testicular cancer (528·5 to 573·5) (16·8 to 38·7) (47·5 to 64·2)* (19·0 to 31·4)* (12·7 to 25·4)* (5·2 to 16·2)*
testicular cancer (8·7 to 9·4) (2·8 to 5·4) (26·1 to 35·8)* (13·1 to 21·2)* (−7·2 to −0·3)* (−3·5 to 3·4)
Terminal phase of testicular 1·0 ·· 0·6 22·7% 9·9% −8·8% −5·7%
Kidney cancer 2184·1 393·0 141·0 50·2% 24·1% 7·2% −2·2%
(2081·8 to 2249·0) (371·2 to 404·6) (101·2 to 190·1) (44·0 to 58·6)* (18·8 to 28·9)* (3·5 to 12·3)* (−6·3 to 1·6)
Diagnosis and primary ·· 393·0 ·· ·· ·· ·· ··
therapy phase of kidney (371·2 to 404·6)
cancer
Controlled phase of kidney 2080·7 ·· 95·6 47·6% 22·6% 8·2% −2·0%
cancer (1985·3 to 2143·1) (62·2 to 139·5) (39·9 to 57·7)* (16·8 to 27·7)* (3·8 to 14·7)* (−6·7 to 2·0)
Metastatic phase of kidney 86·7 ·· 36·4 55·9% 27·2% 5·1% −2·6%
Terminal phase of kidney 16·7 ·· 9·0 57·3% 27·0% 5·8% −3·0%
Bladder cancer 2632·4 473·8 247·0 47·3% 33·0% −1·9% 0·9%
(2566·9 to 2717·2) (462·2 to 491·8) (179·4 to 322·8) (43·4 to 53·6)* (29·9 to 36·2)* (−4·6 to 2·2) (−1·4 to 3·3)
therapy phase of bladder (138·1 to 146·6) (462·2 to 491·8) (25·4 to 50·8) (41·0 to 56·0)* (29·3 to 39·3)* (−5·4 to 4·2) (−1·5 to 6·0)
cancer
Controlled phase of bladder 2269·1 ·· 139·9 50·9% 34·1% 2·0% 2·7%
Metastatic phase of bladder 121·5 ·· 48·2 37·7% 29·9% −10·3% −3·1%


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Terminal phase of bladder 22·6 ·· 11·6 38·0% 29·5% −10·4% −3·5%
Incontinence from bladder 77·5 ·· 10·0 63·5% 32·3% 5·2% −0·8%
cancer, beyond 10 years (74·8 to 80·5) (6·8 to 14·1) (57·7 to 69·4)* (27·9 to 37·3)* (1·6 to 9·2)* (−4·1 to 2·9)
Brain and nervous system 1705·7 405·2 166·9 56·9% 49·9% 19·1% 24·8%
cancer (1471·0 to 1894·8) (351·0 to 442·6) (117·5 to 223·0) (34·3 to 85·1)* (41·3 to 58·9)* (2·2 to 37·8)* (17·7 to 32·8)*
therapy phase of brain and (86·4 to 110·7) (351·0 to 442·6) (19·0 to 40·4) (51·1 to 107·8)* (51·3 to 71·1)* (15·7 to 55·6)* (27·5 to 44·1)*
nervous system cancers
Controlled phase of brain 1453·1 ·· 68·5 72·1% 61·9% 35·8% 38·0%
and nervous system cancers (1251·8 to 1625·0) (43·3 to 102·1) (45·5 to 109·1)* (50·1 to 74·9)* (16·1 to 61·4)* (28·0 to 49·2)*
Metastatic phase of brain 130·1 ·· 57·7 41·8% 36·5% 4·9% 10·9%
and nervous system cancers (112·7 to 139·8) (38·4 to 78·2) (22·1 to 62·1)* (30·0 to 42·0)* (−9·4 to 17·6) (5·6 to 15·2)*
Terminal phase of brain and 22·6 ·· 12·2 38·7% 34·3% 3·0% 8·8%
nervous system cancers (19·6 to 24·3) (8·4 to 15·9) (18·9 to 59·0)* (27·8 to 39·3)* (−10·8 to 15·6) (3·7 to 12·9)*
Thyroid cancer 2144·9 255·5 132·0 95·1% 37·7% 33·4% 11·4%
(2059·5 to 2287·8) (245·7 to 272·5) (91·7 to 180·8) (87·1 to 104·5)* (32·4 to 44·0)* (27·9 to 39·2)* (7·1 to 16·5)*
therapy phase of thyroid (55·5 to 61·6) (245·7 to 272·5) (11·1 to 23·1) (91·6 to 109·7)* (32·3 to 45·3)* (32·6 to 43·9)* (7·6 to 18·1)*
cancer
Controlled phase of thyroid 2040·7 ·· 94·5 101·9% 38·1% 40·1% 12·9%
Metastatic phase of thyroid 42·9 ·· 19·0 67·5% 35·7% 9·9% 4·3%
Terminal phase of thyroid 3·5 ·· 1·9 63·9% 34·7% 8·6% 3·9%
Mesothelioma 78·6 34·6 14·9 33·7% 23·9% −10·0% −4·6%
(76·1 to 81·1) (33·5 to 35·7) (10·6 to 19·7) (17·7 to 56·9)* (16·2 to 30·9)* (−20·4 to 5·2) (−10·3 to 0·7)
therapy phase of (8·8 to 9·4) (33·5 to 35·7) (1·7 to 3·6) (20·0 to 58·2)* (17·0 to 31·2)* (−19·0 to 6·2) (−9·8 to 1·0)
mesothelioma
mesothelioma (45·3 to 48·3) (1·4 to 3·2) (18·0 to 58·3)* (14·8 to 32·4)* (−19·8 to 7·0) (−11·0 to 2·3)
mesothelioma (19·3 to 20·6) (5·9 to 11·6) (17·0 to 56·9)* (15·3 to 32·1)* (−20·9 to 4·9) (−11·1 to 1·4)
mesothelioma (2·7 to 2·9) (1·0 to 1·9) (16·2 to 53·5)* (17·1 to 30·2)* (−21·7 to 2·5) (−9·8 to −0·2)*
Hodgkin lymphoma 657·1 101·1 50·5 31·2% 19·1% −1·0% 2·5%
(568·9 to 780·8) (88·0 to 118·7) (35·1 to 69·3) (18·9 to 59·3)* (13·8 to 23·7)* (−10·3 to 19·8) (−2·2 to 6·5)
therapy phase of Hodgkin (18·8 to 25·9) (88·0 to 118·7) (4·1 to 9·0) (30·3 to 77·5)* (17·3 to 27·3)* (0·9 to 35·5)* (2·0 to 10·6)*
lymphoma
Hodgkin lymphoma (520·5 to 716·2) (17·5 to 43·0) (29·2 to 77·6)* (16·1 to 27·8)* (0·4 to 36·7)* (1·4 to 11·3)*
Hodgkin lymphoma (26·7 to 36·1) (9·1 to 19·0) (4·6 to 33·3)* (8·3 to 17·3)* (−23·0 to −3·0)* (−9·1 to −1·6)*
Terminal phase of Hodgkin 3·2 ·· 1·7 −2·7% 4·6% −28·0% −12·1%
lymphoma (2·7 to 3·7) (1·1 to 2·2) (−10·9 to 13·0) (0·8 to 8·2)* (−33·5 to −17·1)* (−15·3 to −9·1)*
Non-Hodgkin lymphoma 2371·9 488·0 193·1 77·8% 41·4% 26·1% 11·3%
(2325·0 to 2418·1) (478·9 to 496·9) (140·2 to 254·2) (70·5 to 84·3)* (37·7 to 45·0)* (21·4 to 30·3)* (8·2 to 14·2)*
therapy phase of (86·0 to 89·4) (478·9 to 496·9) (16·4 to 33·1) (82·5 to 97·4)* (40·5 to 49·9)* (30·7 to 39·7)* (10·8 to 18·3)*
non-Hodgkin lymphoma
non-Hodgkin lymphoma (2077·3 to 2161·3) (62·9 to 140·5) (83·9 to 99·1)* (41·4 to 49·4)* (33·9 to 42·8)* (12·3 to 18·9)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Terminal phase of 24·1 ·· 12·9 57·3% 34·0% 9·4% 3·8%
Multiple myeloma 449·3 152·7 90·8 93·4% 44·3% 29·7% 10·3%
(414·6 to 520·9) (140·6 to 172·7) (64·2 to 118·4) (85·2 to 102·7)* (38·6 to 50·3)* (24·3 to 35·4)* (5·9 to 14·7)*
therapy phase of multiple (26·0 to 32·7) (140·6 to 172·7) (5·3 to 11·2) (110·1 to 130·1)* (43·2 to 54·8)* (43·2 to 55·9)* (10·2 to 19·0)*
myeloma
multiple myeloma (233·7 to 294·6) (7·5 to 17·3) (107·1 to 135·2)* (42·0 to 56·3)* (41·5 to 60·1)* (9·7 to 20·7)*
multiple myeloma (145·3 to 181·5) (44·2 to 85·7) (80·8 to 100·4)* (37·3 to 50·4)* (21·3 to 34·0)* (4·8 to 14·8)*
Terminal phase of multiple 10·9 ·· 5·9 63·8% 35·8% 8·5% 2·4%
myeloma (10·1 to 12·3) (4·1 to 7·6) (53·4 to 68·1)* (31·5 to 39·8)* (0·7 to 11·3)* (−0·9 to 5·5)
Leukaemia 2432·4 518·5 263·3 27·8% 25·1% −3·6% 2·3%
(2190·3 to 2591·6) (472·2 to 548·0) (191·2 to 342·0) (13·5 to 38·0)* (19·7 to 29·5)* (−12·7 to 2·1) (−2·3 to 6·5)
Acute lymphoid leukaemia 521·1 64·2 43·0 29·9% 31·6% 11·1% 18·6%
(433·1 to 579·5) (56·4 to 70·4) (30·6 to 58·6) (3·6 to 46·7)* (11·9 to 47·7)* (−9·4 to 24·0) (0·3 to 33·7)*
Diagnosis and primary 32·0 64·2 9·2 18·6% 11·8% 0·6% −1·0%
therapy phase of acute (28·1 to 35·1) (56·4 to 70·4) (6·1 to 13·0) (−6·0 to 33·6) (−3·0 to 21·9) (−18·0 to 11·8) (−14·5 to 8·0)
lymphoid leukaemia
Controlled phase of acute 465·2 ·· 22·6 39·6% 48·4% 24·4% 36·8%
lymphoid leukaemia (383·8 to 521·0) (14·0 to 34·1) (10·2 to 59·8)* (20·2 to 69·2)* (−0·3 to 41·3) (10·2 to 56·6)*
Metastatic phase of acute 20·1 ·· 9·1 26·3% 21·6% 2·4% 5·8%
lymphoid leukaemia (17·3 to 21·7) (6·0 to 12·4) (3·9 to 42·1)* (10·0 to 31·5)* (−13·6 to 13·8) (−4·5 to 14·3)
Terminal phase of acute 3·7 ·· 2·0 25·4% 20·8% 2·0% 5·2%
Chronic lymphoid 567·7 90·6 74·6 72·3% 42·7% 12·5% 7·3%
leukaemia (534·1 to 600·4) (85·6 to 95·6) (54·8 to 96·5) (65·5 to 80·3)* (36·5 to 49·1)* (7·8 to 17·7)* (2·5 to 12·3)*
therapy phase of chronic (28·6 to 32·1) (85·6 to 95·6) (5·8 to 11·9) (71·6 to 84·8)* (39·0 to 52·0)* (13·6 to 22·7)* (5·5 to 15·7)*
lymphoid leukaemia
chronic lymphoid (399·1 to 449·4) (12·7 to 28·2) (75·4 to 91·3)* (39·4 to 54·0)* (18·0 to 28·5)* (6·9 to 17·9)*
leukaemia
chronic lymphoid (103·0 to 114·8) (31·2 to 58·5) (59·1 to 77·9)* (33·9 to 48·3)* (2·8 to 14·8)* (0·0 to 10·7)*
leukaemia
Terminal phase of chronic 4·0 ·· 2·2 58·4% 35·9% 1·6% 0·5%
Acute myeloid leukaemia 150·9 119·6 28·8 52·6% 22·9% 13·5% 1·0%
(137·0 to 160·0) (108·4 to 125·9) (20·2 to 37·7) (24·2 to 72·6)* (12·9 to 30·0)* (−4·6 to 25·4) (−7·1 to 6·7)
therapy phase of acute (108·4 to 125·9)
myeloid leukaemia
Controlled phase of acute 99·2 ·· 4·8 63·3% 18·7% 26·4% 0·0%
myeloid leukaemia (90·5 to 105·8) (3·0 to 7·2) (25·1 to 91·8)* (7·4 to 27·0)* (1·9 to 44·0)* (−9·5 to 7·1)
Metastatic phase of acute 42·5 ·· 19·0 50·4% 23·8% 11·1% 1·1%
myeloid leukaemia (38·5 to 44·7) (12·5 to 25·5) (23·7 to 69·1)* (14·0 to 30·8)* (−6·0 to 22·1) (−6·4 to 6·8)
Terminal phase of acute 9·2 ·· 5·0 51·0% 24·0% 11·6% 1·2%
myeloid leukaemia (8·4 to 9·7) (3·4 to 6·5) (24·2 to 69·8)* (14·2 to 30·8)* (−5·6 to 22·6) (−6·2 to 6·8)
Chronic myeloid leukaemia 95·8 34·2 11·7 6·5% 6·6% −28·1% −15·0%
(88·3 to 103·2) (31·5 to 36·7) (8·4 to 15·4) (1·3 to 11·2)* (3·0 to 10·0)* (−31·5 to −24·8)* (−17·9 to −12·1)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
therapy phase of chronic (6·4 to 7·4) (31·5 to 36·7) (1·3 to 2·8) (8·5 to 18·5)* (3·9 to 11·0)* (−26·6 to −20·3)* (−16·6 to −10·8)*
myeloid leukaemia
chronic myeloid leukaemia (70·1 to 82·0) (2·4 to 5·6) (12·1 to 23·7)* (3·9 to 11·5)* (−23·2 to −15·2)* (−15·8 to −9·5)*
Metastatic phase of 10·6 ·· 4·8 −1·3% 5·5% −33·5% −16·7%
chronic myeloid (9·7 to 11·3) (3·2 to 6·4) (−6·1 to 2·9) (2·0 to 9·1)* (−36·6 to −30·5)* (−19·7 to −13·8)*
leukaemia
Terminal phase of chronic 2·3 ·· 1·2 −1·7% 5·5% −33·9% −16·8%
myeloid leukaemia (2·1 to 2·5) (0·9 to 1·6) (−6·3 to 2·6) (1·9 to 9·1)* (−36·7 to −31·1)* (−19·6 to −13·9)*
Other leukaemia 1096·8 209·9 105·3 9·1% 15·4% −14·8% −4·0%
(930·7 to 1204·2) (180·8 to 227·5) (74·7 to 137·1) (−6·7 to 25·2) (8·5 to 22·4)* (−25·1 to −5·3)* (−9·7 to 1·9)
therapy phase of other (180·8 to 227·5)
leukaemia
Controlled phase of other 957·9 ·· 45·4 7·6% 13·1% −8·8% −1·1%
leukaemia (808·7 to 1058·8) (28·5 to 67·6) (−13·7 to 33·7) (1·7 to 25·4)* (−24·9 to 9·7) (−11·7 to 10·0)
Metastatic phase of other 130·2 ·· 55·1 10·8% 17·4% −18·7% −6·0%
leukaemia (114·4 to 139·3) (37·6 to 72·8) (−0·2 to 20·4) (13·1 to 23·7)* (−25·8 to −13·5)* (−9·4 to −1·3)*
Terminal phase of other 8·8 ·· 4·7 6·4% 15·2% −20·7% −7·6%
leukaemia (7·7 to 9·4) (3·3 to 6·1) (−4·0 to 17·1) (11·1 to 20·7)* (−27·2 to −15·4)* (−10·9 to −3·4)*
Other malignant cancers 9176·2 715·5 678·1 99·7% 149·2% 46·4% 107·7%
(8080·3 to 10 439·8) (656·3 to 740·0) (481·1 to 910·4) (84·8 to 118·8)* (122·1 to 179·0)* (35·6 to 60·0)* (84·2 to 133·3)*
therapy phase of other (181·3 to 231·1) (656·3 to 740·0) (38·0 to 80·5) (107·3 to 150·6)* (146·5 to 210·3)* (55·4 to 83·7)* (107·0 to 161·9)*
malignant neoplasms
Controlled phase of other 8451·7 ·· 397·1 140·6% 204·9% 86·8% 161·4%
malignant neoplasms (7437·1 to 9683·5) (252·9 to 592·8) (114·5 to 174·5)* (166·8 to 245·8)* (68·6 to 109·9)* (127·6 to 198·8)*
Metastatic phase of other 460·4 ·· 188·6 67·0% 86·3% 18·3% 49·1%
Terminal phase of other 68·0 ·· 35·8 62·1% 77·1% 14·2% 40·7%
Other neoplasms 25 223·0 11 159·5 55·1 47·4% 34·5% 4·7% 6·0%
(24 682·1 to 25 725·3) (10 928·2 to 11 416·2) (35·2 to 80·9) (42·6 to 52·3)* (31·6 to 37·3)* (1·8 to 7·7)* (4·0 to 7·9)*
Myelodysplastic, 1212·2 134·3 55·1 47·4% 34·5% 4·7% 6·0%
myeloproliferative, and (1098·1 to 1332·1) (118·4 to 148·9) (35·2 to 80·9) (42·6 to 52·3)* (31·6 to 37·3)* (1·8 to 7·7)* (4·0 to 7·9)*
other haemopoietic
neoplasms
Benign and in-situ 3966·3 1010·9 ·· ·· ·· ·· ··
intestinal neoplasms (3840·7 to 4110·3) (980·1 to 1049·4)
Benign and in-situ cervical 1180·0 299·4 ·· ·· ·· ·· ··
and uterine neoplasms (1138·1 to 1223·0) (287·6 to 312·8)
Other benign and in-situ 19 417·1 9715·0 ·· ·· ·· ·· ··
neoplasms (18 926·5 to 19 882·6) (9488·7 to 9966·6)
Cardiovascular diseases 485 620·9 72 721·2 35 697·3 39·8% 34·3% −5·5% 4·5%
(468 031·7 to 504 964·4) (70 388·1 to 75 264·1) (26 428·2 to (38·8 to 40·8)* (32·0 to 37·0)* (−6·2 to −4·8)* (2·9 to 6·4)*
45 510·3)
Rheumatic heart disease 39 345·4 1311·3 1901·0 40·9% 16·0% 7·3% 2·4%
(37 960·8 to 40 828·7) (1269·4 to 1354·9) (1232·8 to 2766·0) (40·0 to 41·8)* (15·3 to 16·7)* (6·7 to 7·9)* (1·9 to 3·1)*
Rheumatic heart disease 38 145·4 1311·3 1797·9 40·0% 15·4% 7·3% 2·6%
without heart failure (36 705·9 to 39 639·2) (1269·4 to 1354·9) (1160·7 to 2619·0) (39·2 to 40·9)* (14·8 to 16·1)* (6·7 to 7·9)* (2·0 to 3·2)*
Heart failure due to 1199·9 ·· 103·1 58·9% 27·2% 7·9% −0·1%
rheumatic heart disease (1006·1 to 1403·8) (69·7 to 145·1) (54·7 to 62·6)* (24·4 to 30·2)* (5·3 to 10·3)* (−2·2 to 1·9)
Ischaemic heart disease 126 451·5 10 636·5 5291·9 35·8% 23·5% −10·9% −5·2%
(118 587·5 to 134 706·5) (9573·2 to 11 794·5) (3657·3 to 7238·9) (34·5 to 37·0)* (22·9 to 24·2)* (−11·9 to −10·0)* (−5·7 to −4·7)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Asymptomatic ischaemic 37 908·6 ·· ·· ·· ·· ·· ··
heart disease following (31 907·4 to 44 225·6)
myocardial infarction
Angina due to ischaemic 70 969·3 ·· 3850·4 35·1% 22·9% −10·0% −4·6%
heart disease (66 224·1 to 75 830·1) (2615·6 to 5381·2) (34·3 to 35·9)* (22·2 to 23·5)* (−10·4 to −9·5)* (−5·0 to −4·2)*
Heart failure due to 17 007·2 ·· 1388·9 37·2% 25·9% −13·5% −6·4%
ischaemic heart disease (14 512·0 to 19 849·5) (951·7 to 1947·2) (33·2 to 41·7)* (24·3 to 27·5)* (−16·2 to −10·7)* (−7·6 to −5·1)*
Myocardial infarction due 566·4 10 636·5 52·7 48·9% 13·6% −4·2% −14·6%
to ischaemic heart disease (505·5 to 634·4) (9573·2 to 11 794·5) (36·6 to 72·9) (46·1 to 51·7)* (10·5 to 16·6)* (−5·9 to −2·5)* (−17·0 to −12·3)*
Stroke 104 178·7 11 931·1 18 695·4 40·0% 43·6% −4·7% 11·2%
(98 454·0 to 110 125·0) (11 118·4 to 12 825·8)‡ (13 574·3 to (38·4 to 41·4)* (39·6 to 47·8)* (−5·8 to −3·7)* (8·1 to 14·3)*
23 686·9)
Ischaemic stroke 82 417·3 7737·5 14 304·4 42·8% 54·3% −4·1% 18·1%
(76 967·8 to 88 516·9) (6951·1 to 8677·6)‡ (10 297·5 to (40·6 to 44·9)* (49·1 to 59·4)* (−5·5 to −2·7)* (14·1 to 22·0)*
18 176·0)
Acute ischaemic stroke 587·5 7737·5 144·3 40·1% 43·0% −6·9% 8·8%
(529·1 to 655·7) (6951·1 to 8677·6)‡ (100·1 to 188·1) (37·4 to 42·9)* (37·0 to 49·4)* (−8·5 to −5·2)* (4·3 to 13·6)*
Chronic ischaemic stroke 81 829·7 ·· 14 160·1 42·8% 54·4% −4·1% 18·2%
(76 384·9 to 87 926·6) (10 204·3 to (40·6 to 45·0)* (49·2 to 59·6)* (−5·4 to −2·7)* (14·1 to 22·2)*
17 970·9)
Intracerebral haemorrhage 17 914·9 3128·6 2946·9 32·1% 13·9% −6·8% −9·5%
(16 190·6 to 19 666·6) (2874·6 to 3418·0)‡ (2121·6 to 3794·1) (29·9 to 34·3)* (8·0 to 20·3)* (−8·2 to −5·4)* (−14·2 to −4·8)*
Acute intracerebral 168·7 3128·6 44·3 39·4% −1·9% −5·5% −24·4%
haemorrhage (154·2 to 184·6) (2874·6 to 3418·0)‡ (31·0 to 57·8) (36·8 to 42·4)* (−6·8 to 3·2) (−7·3 to −3·7)* (−28·1 to −20·6)*
Chronic intracerebral 17 746·2 ·· 2902·6 32·0% 14·2% −6·8% −9·3%
haemorrhage (16 029·3 to 19 493·5) (2090·3 to 3738·5) (29·8 to 34·1)* (8·1 to 20·6)* (−8·3 to −5·4)* (−14·0 to −4·4)*
Subarachnoid haemorrhage 9321·9 1064·9 1444·2 36·8% 25·0% −5·7% −1·6%
(8523·7 to 10 242·4) (953·3 to 1182·6)‡ (1031·6 to 1845·4) (34·7 to 38·9)* (21·3 to 28·6)* (−7·1 to −4·3)* (−4·4 to 1·2)
Acute subarachnoid 80·5 1064·9 21·1 40·2% 25·2% −4·6% −1·6%
haemorrhage (71·7 to 89·5) (953·3 to 1182·6)‡ (14·5 to 28·0) (31·1 to 43·9)* (19·8 to 27·2)* (−10·2 to −2·5)* (−5·5 to −0·2)*
Chronic subarachnoid 9241·4 ·· 1423·1 36·7% 25·0% −5·7% −1·6%
haemorrhage (8444·1 to 10 171·4) (1016·6 to 1817·9) (34·6 to 38·8)* (21·2 to 28·6)* (−7·1 to −4·3)* (−4·4 to 1·2)
Hypertensive heart disease 17 067·7 ·· 1408·0 63·8% 34·9% 6·0% 1·9%
(14 426·9 to 19 874·3) (966·6 to 1982·4) (60·5 to 67·2)* (33·2 to 36·6)* (3·8 to 8·2)* (0·7 to 2·9)*
Non-rheumatic valvular heart 29 729·1 30 691·2 360·8 54·9% 35·8% −4·5% −1·0%
disease (28 505·4 to 31 022·5) (29 436·4 to 32 002·2) (207·1 to 559·6) (49·0 to 61·0)* (30·9 to 40·7)* (−7·7 to −1·7)* (−4·3 to 2·1)
Non-rheumatic calcific 12 570·2 12 570·2 168·0 64·8% 38·9% −0·2% 0·2%
aortic valve disease (11 411·8 to 13 841·1) (11 411·8 to 13 841·1) (96·6 to 259·9) (56·5 to 73·5)* (30·9 to 46·2)* (−5·1 to 4·3) (−5·9 to 5·3)
Heart failure due to calcific 1386·0 ·· 111·0 42·3% 30·6% −14·1% −6·0%
aortic valve disease (896·6 to 2029·9) (63·7 to 173·8) (30·1 to 56·6)* (13·2 to 47·6)* (−21·4 to −6·0)* (−19·0 to 6·2)
Non-rheumatic calcific 11 184·2 12 570·2 56·9 163·9% 58·7% 62·6% 15·0%
aortic valve disease (9987·3 to 12 425·7) (11 411·8 to 13 841·1) (30·4 to 93·2) (124·2 to 209·0)* (36·3 to 84·3)* (37·1 to 93·2)* (−1·6 to 34·3)
Non-rheumatic 18 121·0 18 121·0 190·3 47·4% 33·2% −8·1% −2·0%
degenerative mitral valve (17 682·3 to 18 586·4) (17 682·3 to 18 586·4) (109·2 to 295·3) (41·5 to 52·7)* (28·1 to 38·0)* (−11·5 to −5·4)* (−5·6 to 1·2)
disease
Heart failure due to 1723·6 ·· 139·9 33·3% 26·7% −17·1% −6·8%
degenerative mitral valve (1111·4 to 2494·0) (81·5 to 217·1) (25·0 to 43·1)* (15·5 to 38·6)* (−22·2 to −11·4)* (−15·0 to 2·0)
disease
Non-rheumatic 16 397·4 18 121·0 50·5 129·8% 55·2% 44·9% 14·0%
degenerative mitral valve (15 574·9 to 17 179·2) (17 682·3 to 18 586·4) (26·7 to 84·0) (95·6 to 171·4)* (33·1 to 78·0)* (22·1 to 72·2)* (−2·5 to 30·9)
disease
Other non-rheumatic valve 26·9 ·· 2·5 63·1% 37·7% 7·4% 6·1%
diseases (22·1 to 32·2) (1·6 to 3·6) (58·9 to 67·2)* (34·1 to 41·1)* (5·1 to 9·4)* (4·1 to 8·1)*
Mild heart failure due to 5·0 ·· 0·2 63·6% 38·0% 7·7% 6·2%
other non-rheumatic (3·5 to 6·8) (0·1 to 0·3) (59·2 to 68·1)* (34·5 to 41·4)* (5·4 to 9·9)* (4·2 to 8·1)*
valve disease


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Moderate heart failure 3·3 ·· 0·2 63·6% 38·0% 7·7% 6·2%
due to other non- (2·2 to 4·4) (0·1 to 0·4) (59·0 to 68·0)* (34·5 to 41·6)* (5·3 to 10·0)* (4·0 to 8·2)*
rheumatic valve disease
Severe heart failure due 8·8 ·· 1·5 63·0% 37·7% 7·3% 6·1%
to other non-rheumatic (6·9 to 10·9) (1·0 to 2·3) (58·7 to 67·4)* (33·6 to 41·6)* (4·8 to 9·8)* (3·7 to 8·8)*
valve disease
Controlled, medically 9·9 ·· 0·5 63·2% 37·6% 7·4% 6·1%
managed heart failure due (8·0 to 12·1) (0·3 to 0·7) (58·8 to 67·6)* (33·5 to 41·6)* (5·0 to 10·0)* (3·3 to 8·7)*
to other non-rheumatic
valve disease
Cardiomyopathy and 5429·9 3071·0 623·8 27·4% 21·2% −12·6% −3·9%
myocarditis (4694·4 to 6257·1) (2745·0 to 3451·2) (424·7 to 859·3) (24·5 to 30·9)* (19·2 to 23·0)* (−14·9 to −10·3)* (−5·0 to −2·9)*
Myocarditis 1804·6 3071·0 131·4 26·6% 15·9% −5·4% −1·9%
(1635·3 to 1983·8) (2745·0 to 3451·2) (90·1 to 183·0) (23·9 to 29·6)* (13·9 to 18·0)* (−6·8 to −4·1)* (−3·0 to −0·9)*
Acute myocarditis 740·8 3071·0 35·7 33·3% 19·1% −2·4% −1·3%
(656·3 to 830·8) (2745·0 to 3451·2) (22·5 to 52·6) (30·5 to 36·2)* (16·7 to 21·6)* (−4·0 to −0·6)* (−2·9 to 0·2)
myocarditis (914·1 to 1215·2) (63·9 to 133·5) (21·0 to 28·2)* (12·3 to 17·3)* (−8·1 to −4·9)* (−3·4 to −0·8)*
Alcoholic cardiomyopathy 1621·8 ·· 139·1 20·7% 15·5% −17·9% −9·5%
(1370·5 to 1902·4) (95·1 to 196·1) (16·8 to 25·1)* (12·9 to 18·1)* (−20·5 to −15·2)* (−11·2 to −7·7)*
Other cardiomyopathy 4212·7 ·· 353·3 30·8% 25·7% −12·8% −2·5%
(3634·6 to 4869·9) (237·9 to 493·9) (27·2 to 34·9)* (23·4 to 27·9)* (−15·6 to −9·9)* (−3·9 to −1·0)*
Atrial fibrillation and flutter 37 574·2 3046·0 2921·5 49·0% 31·4% −3·7% −1·2%
(32 548·8 to 42 588·4) (2605·8 to 3507·2) (1992·6 to 4034·2) (46·7 to 51·7)* (30·3 to 32·5)* (−5·1 to −1·9)* (−1·9 to −0·6)*
Asymptomatic atrial 22 545·7 3046·0 ·· ·· ·· ·· ··
fibrillation and flutter (19 530·0 to 25 680·2) (2605·8 to 3507·2)
Symptomatic atrial 15 028·5 ·· 2921·5 49·0% 31·4% −3·7% −1·2%
fibrillation and flutter (13 016·1 to 17 142·8) (1992·6 to 4034·2) (46·7 to 51·7)* (30·3 to 32·5)* (−5·1 to −1·9)* (−1·9 to −0·6)*
Peripheral vascular disease 118 123·6 10 811·7 515·6 40·0% 27·8% −8·5% −4·7%
(102 706·9 to 134 350·4) (9282·1 to 12 503·4) (237·6 to 938·4) (37·6 to 42·8)* (26·6 to 29·3)* (−9·6 to −7·0)* (−5·5 to −3·6)*
Asymptomatic peripheral 78 631·6 10 811·7 ·· ·· ·· ·· ··
arterial disease (66 970·1 to 91 233·4) (9282·1 to 12 503·4)
Symptomatic claudication 39 492·0 ·· 515·6 40·0% 27·8% −8·5% −4·7%
due to peripheral arterial (31 074·7 to 50 227·2) (237·6 to 938·4) (37·6 to 42·8)* (26·6 to 29·3)* (−9·6 to −7·0)* (−5·5 to −3·6)*
disease
Endocarditis 654·1 1222·5 53·8 31·1% 24·6% −10·7% −2·5%
(567·5 to 743·8) (1097·6 to 1334·0) (36·6 to 75·3) (27·3 to 35·6)* (22·1 to 27·3)* (−14·3 to −7·2)* (−4·4 to −0·8)*
Acute endocarditis 87·9 1222·5 4·9 34·3% 26·2% 2·1% 4·3%
(78·3 to 96·3) (1097·6 to 1334·0) (3·2 to 7·3) (31·7 to 36·9)* (23·2 to 29·2)* (1·4 to 2·9)* (2·3 to 6·4)*
endocarditis (480·9 to 655·8) (33·3 to 68·7) (26·5 to 35·7)* (21·8 to 27·4)* (−15·5 to −8·1)* (−5·1 to −1·3)*
Other cardiovascular and 75 599·8 ·· 3925·4 32·5% 24·4% −9·1% −0·5%
circulatory diseases (64 068·9 to 88 170·3) (2650·1 to 5544·1) (30·0 to 35·5)* (22·5 to 26·2)* (−10·9 to −6·9)* (−1·4 to 0·4)
Heart failure due to other 1562·0 ·· 129·6 32·6% 30·0% −15·0% −2·0%
cardiovascular diseases (1279·4 to 1882·1) (86·6 to 185·3) (28·4 to 37·1)* (27·5 to 32·6)* (−18·0 to −12·0)* (−3·8 to −0·2)*
Other cardiovascular and 74 037·8 ·· 3795·9 32·4% 24·2% −8·8% −0·4%
circulatory disease episodes (62 741·1 to 86 283·3) (2564·1 to 5373·7) (30·0 to 35·5)* (22·3 to 26·0)* (−10·7 to −6·7)* (−1·3 to 0·5)
Chronic respiratory diseases 544 899·2 62 161·4 44 311·8 21·9% 22·8% −12·5% −0·4%
(506 937·5 to 584 858·4) (55 134·8 to 69 320·7) (36 751·6 to (19·7 to 24·3)* (19·0 to 26·5)* (−13·7 to −11·3)* (−3·3 to 2·5)
51 407·1)
Chronic obstructive 299 398·2 18 475·7 30 611·5 24·9% 23·8% −14·1% −2·8%
pulmonary disease (269 025·2 to 330 073·8) (16 736·0 to 20 255·6) (26 034·9 to (22·7 to 27·2)* (18·6 to 28·6)* (−15·5 to −12·6)* (−6·9 to 0·9)
34 813·0)
Chronic obstructive 14 890·7 ·· 5673·6 66·5% 36·1% 5·4% 1·3%
pulmonary disease with (12 183·6 to 17 715·3) (4163·8 to 7049·6) (61·8 to 71·3)* (32·1 to 39·1)* (2·6 to 8·1)* (−1·1 to 3·4)
heart failure


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Chronic obstructive 284 507·4 18 475·7 24 937·9 18·9% 21·3% −17·6% −3·7%
pulmonary disease without (254 368·4 to 315 515·1) (16 736·0 to 20 255·6) (21 040·1 to (16·3 to 21·5)* (15·4 to 26·8)* (−19·3 to −15·8)* (−8·4 to 0·6)
heart failure 28 738·5)
Pneumoconiosis 527·5 60·1 80·5 41·3% 27·0% −3·8% −2·0%
(470·0 to 593·2) (53·1 to 67·0) (54·5 to 111·5) (36·5 to 46·3)* (22·8 to 31·2)* (−6·9 to −0·7)* (−5·2 to 1·1)
Silicosis 162·4 23·7 24·9 45·4% 29·1% −0·0% 0·2%
(127·5 to 202·6) (19·1 to 29·0) (16·0 to 36·0) (36·4 to 54·7)* (21·3 to 37·1)* (−5·9 to 6·1) (−5·8 to 6·4)
silicosis (9·1 to 13·1) (3·4 to 6·9) (58·4 to 70·9)* (26·8 to 35·3)* (5·1 to 13·1)* (−4·8 to 1·9)
Silicosis without heart 151·4 23·7 19·8 41·3% 28·6% −2·1% 0·6%
failure (117·1 to 190·0) (19·1 to 29·0) (12·2 to 29·4) (30·6 to 52·9)* (19·0 to 38·5)* (−9·3 to 5·9) (−6·9 to 8·3)
Asbestosis 92·1 9·4 14·4 42·6% 35·0% −2·1% 4·4%
(73·1 to 118·3) (7·7 to 11·6) (9·2 to 21·6) (32·3 to 53·9)* (29·6 to 41·3)* (−9·1 to 5·2) (0·6 to 8·6)*
Asbestosis without heart 86·6 9·4 11·9 38·3% 36·6% −3·9% 7·1%
failure (67·7 to 112·7) (7·7 to 11·6) (7·4 to 18·2) (27·2 to 50·6)* (30·1 to 44·7)* (−11·9 to 4·7) (2·4 to 12·5)*
asbestosis (4·7 to 6·5) (1·7 to 3·5) (54·7 to 77·6)* (23·8 to 31·8)* (−1·3 to 13·3) (−8·9 to −3·0)*
Coal worker 147·9 15·1 21·9 39·1% 23·1% −6·0% −5·6%
pneumoconiosis (117·5 to 190·1) (12·0 to 19·8) (14·2 to 31·8) (28·8 to 50·1)* (13·8 to 32·3)* (−12·4 to 1·1) (−12·7 to 1·2)
Coal worker 140·9 15·1 18·7 36·5% 22·4% −7·3% −6·0%
pneumoconiosis without (110·7 to 182·6) (12·0 to 19·8) (12·0 to 27·8) (24·8 to 48·9)* (11·6 to 33·0)* (−14·7 to 0·9) (−14·1 to 1·7)
heart failure
Heart failure due to coal 7·0 ·· 3·2 57·8% 27·5% 2·7% −3·1%
worker pneumoconiosis (5·9 to 8·2) (2·2 to 4·3) (51·8 to 64·5)* (23·0 to 32·1)* (−1·6 to 7·1) (−6·6 to 0·4)
Other pneumoconiosis 125·1 11·9 19·3 38·2% 23·3% −6·9% −5·0%
(105·0 to 149·3) (9·9 to 14·3) (12·6 to 28·5) (31·9 to 45·3)* (18·5 to 27·9)* (−10·9 to −2·7)* (−8·4 to −1·6)*
Heart failure due to other 4·1 ·· 1·9 80·7% 27·8% 15·2% −4·5%
pneumoconiosis (3·4 to 4·7) (1·3 to 2·6) (75·2 to 86·3)* (23·5 to 31·9)* (12·3 to 18·2)* (−7·5 to −1·9)*
Other pneumoconiosis 121·0 11·9 17·5 34·9% 22·8% −8·8% −5·0%
without heart failure (100·9 to 145·2) (9·9 to 14·3) (11·2 to 26·0) (28·3 to 42·1)* (17·7 to 27·8)* (−12·9 to −4·5)* (−8·8 to −1·2)*
Asthma 272 677·5 43 123·4 10 622·9 8·0% 19·3% −13·5% 4·9%
(242 295·9 to 304 699·6) (36 191·5 to 50 226·4) (7057·0 to 15 056·4) (5·2 to 10·9)* (15·3 to 23·1)* (−14·9 to −11·9)* (1·0 to 8·4)*
Asymptomatic asthma 99 070·1 15 631·4 ·· ·· ·· ·· ··
(84 654·0 to 114 607·7) (12 827·3 to 18 539·7)
Symptomatic asthma 173 607·4 27 492·0 10 622·9 8·0% 19·3% −13·5% 4·9%
(151 655·5 to 198 619·2) (22 746·9 to 32 507·6) (7057·0 to 15 056·4) (5·2 to 10·9)* (15·3 to 23·1)* (−14·9 to −11·9)* (1·0 to 8·4)*
Interstitial lung disease and 6234·2 502·2 648·2 44·3% 29·1% −2·3% 0·1%
pulmonary sarcoidosis (5661·0 to 6848·2) (458·8 to 550·0) (440·3 to 923·2) (41·7 to 47·3)* (26·5 to 31·8)* (−3·9 to −0·5)* (−1·8 to 2·0)
interstitial lung disease and (322·3 to 505·6) (114·4 to 236·1) (56·2 to 65·6)* (28·6 to 34·2)* (2·8 to 8·4)* (−3·3 to 0·9)
pulmonary sarcoidosis
Interstitial lung disease and 5817·3 502·2 478·5 39·3% 28·2% −4·9% 0·5%
pulmonary sarcoidosis (5242·6 to 6431·9) (458·8 to 550·0) (320·7 to 690·8) (36·3 to 42·8)* (25·3 to 31·5)* (−6·9 to −2·7)* (−1·7 to 2·8)
without heart failure
Other chronic respiratory ·· ·· 2348·7 62·5% 23·8% 21·4% 9·2%
diseases (1930·8 to 2739·6) (58·1 to 67·0)* (19·2 to 28·5)* (17·8 to 25·1)* (5·0 to 13·3)*
Digestive diseases 2 049 831·2 465 978·6 19 939·7 31·1% 20·5% −3·4% 1·3%
(1 983 314·3 to (429 600·4 to (13 858·2 to (29·3 to 32·7)* (19·5 to 21·6)* (−4·1 to −2·7)* (0·6 to 2·0)*
2 122 941·6) 500 015·1) 27 973·1)
Cirrhosis and other chronic 1 500 585·1 5154·9 1745·6 50·7% 34·8% 8·4% 10·4%
liver diseases (1 448 741·6 to (4935·4 to 5366·5) (1221·5 to 2387·3) (49·4 to 52·1)* (33·0 to 36·3)* (7·6 to 9·3)* (9·0 to 11·6)*
1 556 007·5)
Cirrhosis and other chronic 431 116·3 1531·5 488·4 53·7% 33·2% 8·7% 9·0%
liver diseases due to (395 729·0 to 468 718·9) (1419·0 to 1643·9) (337·9 to 665·7) (50·9 to 56·5)* (30·7 to 35·6)* (6·9 to 10·5)* (7·1 to 10·9)*
hepatitis B


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Cirrhosis and other 2974·2 539·5 488·4 53·7% 33·2% 8·7% 9·0%
chronic liver diseases due (2810·2 to 3124·4) (509·2 to 570·8) (337·9 to 665·7) (50·9 to 56·5)* (30·7 to 35·6)* (6·9 to 10·5)* (7·1 to 10·9)*
to hepatitis B,
decompensated
Chronic hepatitis B 391 475·2 ·· ·· ·· ·· ·· ··
without cirrhosis (356 323·1 to 429 032·9)
Cirrhosis and other 36 666·9 992·1 ·· ·· ·· ·· ··
chronic liver diseases due (34 057·4 to 39 502·9) (890·6 to 1095·8)
to hepatitis B,
compensated
liver diseases due to (118 558·2 to 153 823·8) (1086·0 to 1272·2) (300·3 to 596·4) (53·5 to 58·4)* (33·9 to 38·9)* (6·7 to 9·9)* (8·2 to 11·9)*
hepatitis C
to hepatitis C,
decompensated
Chronic hepatitis C 104 133·4 ·· ·· ·· ·· ·· ··
without cirrhosis (88 178·6 to 123 899·7)
to hepatitis C,
compensated
liver diseases due to alcohol (24 252·8 to 28 011·2) (839·9 to 973·5) (280·3 to 551·5) (55·4 to 61·0)* (35·1 to 40·5)* (6·3 to 9·9)* (7·8 to 11·9)*
use
to alcohol,
decompensated
to alcohol, compensated
Cirrhosis due to NASH 892 322·8 367·8 148·6 83·2% 54·6% 25·6% 23·5%
(858 624·9 to 927 954·4) (334·5 to 403·7) (102·8 to 205·0) (78·8 to 87·5)* (51·0 to 58·3)* (22·8 to 28·5)* (20·7 to 26·4)*
Non-alcoholic fatty liver 882 058·3 ·· ·· ·· ·· ·· ··
disease/NASH (847 914·0 to 917 435·7)
liver diseases due to NASH (9358·1 to 11 216·7) (334·5 to 403·7) (102·8 to 205·0) (78·8 to 87·5)* (51·0 to 58·3)* (22·8 to 28·5)* (20·7 to 26·4)*
liver diseases due to other (15 165·6 to 17 954·6) (1084·6 to 1260·7) (192·1 to 386·4) (20·6 to 27·3)* (20·0 to 25·7)* (−0·0 to 5·0) (5·8 to 10·6)*
causes
chronic liver diseases due (1550·5 to 1755·9) (231·4 to 265·9) (192·1 to 386·4) (20·6 to 27·3)* (20·0 to 25·7)* (−0·0 to 5·0) (5·8 to 10·6)*
to other cause,
decompensated
to other cause,
compensated
Upper digestive system 807 369·3 384 665·9 13 042·1 32·0% 19·3% −3·6% 0·6%
diseases (728 919·0 to 888 668·9) (348 550·3 to 419 766·4) (8272·3 to 19 986·6) (29·9 to 33·8)* (18·1 to 20·6)* (−4·5 to −2·7)* (−0·2 to 1·4)
Peptic ulcer disease 17 161·2 6719·1 832·8 22·2% 18·9% −14·2% −1·6%
(15 032·4 to 19 357·3) (6078·7 to 7434·1) (555·4 to 1184·1) (20·1 to 24·6)* (16·5 to 21·1)* (−15·6 to −12·6)* (−3·5 to −0·1)*
Acute peptic ulcer disease 7·8 ·· 2·5 32·0% 12·6% −10·3% −12·2%
(6·8 to 8·9) (1·7 to 3·6) (25·8 to 39·1)* (10·9 to 14·4)* (−14·4 to −5·4)* (−13·1 to −11·3)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Chronic peptic ulcer 17 153·4 6719·1 830·2 22·2% 18·9% −14·2% −1·6%
disease (15 023·5 to 19 349·4) (6078·7 to 7434·1) (553·1 to 1180·9) (20·1 to 24·5)* (16·5 to 21·2)* (−15·6 to −12·6)* (−3·5 to −0·0)*
Gastritis and duodenitis 140 449·0 96 720·4 6196·0 27·7% 18·2% −4·5% 0·3%
(120 336·3 to 161 832·9) (85 853·2 to 108 445·4) (3976·7 to 8960·7) (25·0 to 30·3)* (16·1 to 20·4)* (−5·8 to −3·3)* (−1·2 to 1·7)
Acute gastritis and 40·1 ·· 13·1 27·8% 15·4% −10·2% −6·1%
duodenitis (34·5 to 46·3) (8·6 to 18·7) (25·2 to 30·5)* (13·9 to 16·9)* (−11·4 to −8·9)* (−7·0 to −5·3)*
Chronic gastritis and 140 408·8 96 720·4 6182·8 27·7% 18·2% −4·5% 0·3%
duodenitis (120 292·9 to 161 787·1) (85 853·2 to 108 445·4) (3967·9 to 8944·1) (25·0 to 30·3)* (16·1 to 20·4)* (−5·8 to −3·3)* (−1·2 to 1·7)
Gastro-oesophageal reflux 709 264·3 281 226·3 6013·4 38·5% 20·7% −0·7% 1·3%
disease (625 708·7 to 794 604·2) (246 633·4 to 315 761·3) (3215·9 to 10 192·9) (36·3 to 40·4)* (19·1 to 22·3)* (−1·5 to −0·0)* (0·6 to 2·0)*
Appendicitis 722·7 19 016·1 223·6 27·7% 10·3% 2·3% 0·2%
(673·2 to 775·6) (17 716·4 to 20 344·0) (149·1 to 306·5) (23·9 to 31·9)* (6·6 to 14·0)* (−0·7 to 5·5) (−3·1 to 3·7)
Paralytic ileus and intestinal 140·2 3855·4 44·2 36·0% 25·5% 2·9% 4·2%
obstruction (128·1 to 152·3) (3520·1 to 4187·5) (30·0 to 60·4) (32·4 to 39·3)* (22·8 to 28·4)* (1·2 to 4·5)* (2·1 to 6·4)*
Inguinal, femoral, and 26 490·8 41 182·8 2567·0 21·2% 14·5% −7·1% −2·9%
abdominal hernia (24 196·8 to 28 760·4) (36 372·8 to 46 265·0) (1713·5 to 3550·5) (17·9 to 24·8)* (12·3 to 17·0)* (−8·9 to −5·3)* (−4·4 to −1·2)*
Inflammatory bowel disease 6848·9 4048·8 1019·4 48·5% 21·7% 4·7% −0·2%
(6421·4 to 7304·4) (3776·1 to 4377·4) (705·4 to 1381·8) (44·4 to 52·7)* (18·0 to 25·1)* (1·9 to 7·6)* (−3·1 to 2·3)
Ulcerative colitis 4701·0 2690·9 684·0 54·8% 29·5% 7·7% 4·6%
(4318·4 to 5113·6) (2440·5 to 2994·3) (468·6 to 935·0) (50·4 to 59·5)* (24·9 to 33·9)* (4·8 to 10·9)* (1·2 to 7·8)*
Crohn’s disease 2147·9 1357·8 335·4 38·8% 8·6% −0·1% −8·7%
(2007·7 to 2301·8) (1240·2 to 1484·4) (227·1 to 460·4) (34·0 to 43·8)* (5·0 to 11·8)* (−3·5 to 3·4) (−11·5 to −6·2)*
Vascular intestinal disorders 89·8 619·8 27·1 56·5% 25·2% 12·4% −1·3%
(80·0 to 100·8) (555·7 to 686·7) (18·5 to 36·7) (50·4 to 63·2)* (20·2 to 30·8)* (8·9 to 16·2)* (−5·1 to 2·8)
Gallbladder and biliary 30 575·9 5790·7 26·4 29·3% 27·5% −9·6% 3·9%
diseases (27 503·2 to 34 125·0) (5195·0 to 6386·5) (18·0 to 37·5) (26·7 to 32·1)* (24·1 to 31·3)* (−11·0 to −8·1)* (1·7 to 6·3)*
Pancreatitis 6115·8 1644·2 364·4 52·0% 26·6% 6·5% 2·5%
(5533·9 to 6704·1) (1525·6 to 1769·5) (186·3 to 612·8) (48·7 to 54·8)* (23·3 to 29·7)* (4·1 to 8·3)* (0·0 to 4·9)*
Acute pancreatitis 118·6 1300·9 47·7 33·9% 17·5% −6·6% −4·4%
(107·5 to 130·0) (1181·4 to 1426·0) (34·2 to 63·9) (30·5 to 37·3)* (15·7 to 19·4)* (−8·6 to −4·2)* (−5·6 to −3·2)*
Chronic pancreatitis 5997·3 343·3 316·7 55·5% 28·1% 9·0% 3·7%
(5412·4 to 6583·8) (311·5 to 375·0) (145·2 to 556·1) (52·7 to 58·8)* (24·5 to 31·8)* (7·2 to 11·1)* (0·9 to 6·5)*
Other digestive diseases ·· ·· 879·9 0·9% 30·6% −19·4% 9·5%
(605·6 to 1191·4) (−2·8 to 5·0) (28·9 to 32·1)* (−21·5 to −17·3)* (8·2 to 10·6)*
Neurological disorders 3 121 435·3 1 006 294·5 73 161·8 35·1% 17·8% 0·5% 1·4%
(2 951 124·5 to (907 590·7 to (50 721·9 to (31·9 to 38·1)* (15·8 to 20·2)* (−1·6 to 2·4) (−0·3 to 3·4)
3 316 268·0) 1 098 468·9) 100 409·9)
Alzheimer’s disease and other 44 988·8 7300·6 6570·4 62·7% 36·9% −2·3% −1·7%
dementias (39 716·2 to 50 377·8) (6515·7 to 8133·4) (4678·1 to 8588·5) (60·6 to 64·9)* (35·2 to 38·8)* (−3·3 to −1·2)* (−2·3 to −1·1)*
Parkinson’s disease 8525·4 1025·9 1219·0 69·2% 34·3% 8·9% 1·0%
(7037·3 to 10 185·6) (854·1 to 1229·9) (823·7 to 1662·2) (66·5 to 72·6)* (32·5 to 36·2)* (7·1 to 11·0)* (−0·1 to 2·1)
Epilepsy 27 288·3 2470·8 8561·9 24·1% 15·9% 0·1% 3·4%
(21 576·0 to 33 443·8) (1905·5 to 3062·9) (5380·6 to 12 551·5) (8·0 to 42·9)* (3·5 to 31·2)* (−12·3 to 14·9) (−7·8 to 16·8)
Multiple sclerosis 1761·1 54·9 456·6 41·6% 18·3% −0·9% −2·4%
(1598·2 to 1947·9) (50·1 to 60·8) (327·7 to 595·0) (38·2 to 45·2)* (16·1 to 20·5)* (−3·2 to 1·4) (−4·2 to −0·4)*
Motor neuron disease 237·1 67·3 50·4 39·6% 25·9% 4·6% 4·5%
(211·2 to 264·1) (60·7 to 74·3) (35·7 to 67·5) (36·3 to 43·2)* (23·1 to 28·9)* (3·5 to 5·9)* (3·0 to 6·1)*
Headache disorders 3 072 812·1 995 374·9 54 341·8 34·0% 15·4% 0·4% 1·0%
(2 904 886·2 to (896 864·3 to (35 570·5 to (33·0 to 35·1)* (14·6 to 16·2)* (−0·2 to 1·0) (0·5 to 1·5)*
3 266 065·0) 1 087 335·4) 76 780·4)
Migraine 1 331 364·6 112 933·5 47 245·4 34·2% 15·3% 0·6% 1·1%
(1 237 219·6 to (102 829·9 to 122 899·8) (29 986·7 to (33·1 to 35·4)* (14·5 to 16·2)* (−0·0 to 1·2) (0·6 to 1·7)*
1 433 357·2) 68 669·3)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Medication overuse 83 755·8 ·· 9166·1 35·5% 17·5% −1·4% 0·1%
headache due to migraine (70 723·8 to 97 287·8) (5759·6 to (33·6 to 37·3)* (16·2 to 18·7)* (−2·5 to −0·5)* (−0·3 to 0·6)
13 329·2)
Migraine 1 247 608·8 112 933·5 38 079·3 33·9% 14·8% 1·1% 1·3%
(1 154 817·3 to (102 829·9 to 122 899·8) (23 576·3 to (32·6 to 35·3)* (13·8 to 15·8)* (0·4 to 1·9)* (0·7 to 2·0)*
1 347 980·9) 57 421·4)
Tension-type headache 2 331 334·7 882 441·4 7096·4 32·7% 15·6% −0·9% 0·3%
(2 110 373·3 to (783 241·2 to 975 064·3) (4044·6 to (31·0 to 34·6)* (14·5 to 16·9)* (−1·7 to −0·3)* (−0·1 to 0·6)
2 575 461·4) 11 213·5)
Medication overuse 31 134·3 ·· 3382·8 35·5% 17·5% −1·4% 0·1%
headache due to (21 220·1 to 41 990·3) (1753·7 to 5875·5) (33·5 to 37·5)* (16·0 to 18·8)* (−2·5 to −0·4)* (−0·6 to 0·8)
tension-type headache
Tension-type headache 2 300 200·4 882 441·4 3713·6 30·3% 14·0% −0·5% 0·4%
(2 079 425·9 to (783 241·2 to 975 064·3) (1525·8 to 6887·1) (28·5 to 32·4)* (12·9 to 15·3)* (−1·4 to 0·4) (0·0 to 0·7)*
2 547 509·0)
Other neurological disorders 38·9 ·· 1961·8 35·7% 31·9% 11·8% 19·5%
(25·6 to 53·2) (1276·3 to 2823·8) (19·8 to 54·5)* (18·8 to 47·1)* (−0·5 to 26·1) (7·2 to 33·4)*
Other neurological ·· ·· 1950·3 35·8% 32·0% 11·9% 19·6%
disorders (1267·2 to 2813·5) (19·7 to 54·7)* (18·8 to 47·3)* (−0·5 to 26·4) (7·2 to 33·6)*
due to other neurological (25·6 to 53·2) (6·4 to 18·1) (25·8 to 34·1)* (15·8 to 20·8)* (1·0 to 4·3)* (2·0 to 4·3)*
disorders
Mental disorders 970 812·4 336 996·3 122 746·3 31·6% 13·5% −0·6% −1·1%
(923 455·4 to (315 596·6 to (91 620·8 to (30·5 to 32·7)* (12·9 to 14·1)* (−1·2 to −0·0)* (−1·5 to −0·7)*
1 020 930·6) 362 049·6) 157 883·6)
Schizophrenia 19 776·9 1130·5 12 657·9 38·6% 17·2% −0·0% −0·3%
(17 578·3 to 22 210·7) (1004·6 to 1281·9) (9481·9 to 15 563·7) (37·1 to 40·2)* (16·1 to 18·3)* (−0·8 to 0·7) (−1·1 to 0·4)
Depressive disorders 264 455·6 258 164·5 43 099·9 33·4% 14·3% −1·9% −2·6%
(246 380·1 to 286 312·0) (238 280·7 to 281 665·5) (30 536·4 to (31·0 to 35·8)* (13·1 to 15·6)* (−3·2 to −0·4)* (−3·5 to −1·8)*
58 895·6)
Major depressive disorder 163 044·1 241 893·3 32 846·7 32·1% 12·6% −2·4% −3·6%
(149 530·9 to 178 929·1) (222 032·7 to 265 574·7) (23 081·1 to (29·2 to 35·0)* (11·3 to 14·0)* (−4·0 to −0·6)* (−4·6 to −2·7)*
44 291·2)
Dysthymia 106 904·4 16 271·1 10 253·2 38·3% 20·4% −0·3% 0·8%
(93 445·9 to 122 812·3) (14 236·4 to 18 420·1) (6878·0 to 14 982·1) (35·5 to 41·0)* (18·2 to 22·6)* (−1·8 to 1·3) (−0·8 to 2·3)
Bipolar disorder 45 549·4 4525·2 9293·8 34·0% 15·2% 0·4% 1·2%
(39 864·5 to 52 852·8) (3944·7 to 5237·5) (5868·2 to 13 748·5) (32·6 to 35·4)* (14·0 to 16·6)* (−0·3 to 1·1) (0·6 to 1·8)*
Anxiety disorders 284 360·1 42 340·0 27 121·4 32·3% 12·8% 0·4% −1·2%
(265 607·5 to 304 531·7) (39 597·5 to 45 199·5) (19 248·3 to (30·6 to 34·0)* (11·7 to 14·0)* (−0·5 to 1·3) (−2·0 to −0·4)*
36 106·3)
Eating disorders 15 801·7 9589·7 3351·9 37·7% 18·9% 7·9% 9·4%
(12 596·2 to 19 488·6) (6950·1 to 13 126·9) (2149·3 to 4871·6) (35·4 to 40·0)* (17·3 to 20·5)* (6·8 to 8·9)* (8·2 to 10·5)*
Anorexia nervosa 3360·3 1027·8 715·8 30·9% 13·5% 5·4% 6·2%
(2533·8 to 4321·5) (777·5 to 1329·1) (440·9 to 1066·2) (28·0 to 33·9)* (11·0 to 15·7)* (3·3 to 7·2)* (4·1 to 8·1)*
Bulimia nervosa 12 509·7 8561·9 2636·2 39·7% 20·5% 8·6% 10·3%
(9480·4 to 15 976·5) (5957·9 to 12 142·7) (1660·3 to 3937·1) (36·9 to 42·7)* (18·6 to 22·2)* (7·5 to 9·8)* (9·0 to 11·6)*
Autism spectrum disorders 31 179·7 670·7 4731·3 22·8% 11·4% −0·7% −0·3%
(28 000·9 to 34 413·8) (602·2 to 739·1) (3238·8 to 6518·6) (22·1 to 23·5)* (10·8 to 12·1)* (−1·2 to −0·2)* (−0·8 to 0·3)
Attention-deficit/ 73 317·5 3302·7 888·8 20·1% 6·9% −0·2% −0·6%
hyperactivity disorder (62 267·0 to 85 889·6) (2683·9 to 4031·4) (543·2 to 1411·8) (17·5 to 22·6)* (5·2 to 8·5)* (−2·1 to 1·7) (−2·1 to 0·8)
Conduct disorder 53 228·4 17 273·1 6445·2 16·1% 4·8% 1·5% 2·4%
(41 976·6 to 65 750·3) (13 809·1 to 20 989·8) (3869·6 to (14·4 to 17·8)* (3·1 to 6·5)* (0·1 to 2·9)* (0·9 to 3·8)*
10 299·8)
Idiopathic developmental 100 572·2 ·· 4046·4 13·0% 0·0% −5·8% −8·7%
intellectual disability (58 404·5 to 143 878·6) (1940·2 to 6859·5) (9·1 to 15·9)* (−2·8 to 1·5) (−9·0 to −3·1)* (−11·1 to −7·5)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Other mental disorders 149 478·6 ·· 11 109·6 37·7% 17·6% 0·0% 0·0%
(130 882·3 to 170 462·4) (7355·5 to 15 324·6) (36·9 to 38·6)* (17·0 to 18·3)* (−0·5 to 0·4) (−0·4 to 0·5)
Substance use disorders 175 588·8 60 099·6 31 052·9 34·3% 16·7% 2·2% 2·9%
(161 747·6 to 189 304·3) (53 685·6 to 67 048·7) (22 217·1 to (32·2 to 36·2)* (14·4 to 19·2)* (1·1 to 3·4)* (0·8 to 5·1)*
40 499·7)
Alcohol use disorders 107 420·2 52 406·2 10 712·5 35·9% 10·1% 0·9% −4·3%
(95 908·0 to 119 660·2) (45 976·6 to 59 250·1) (7368·0 to 14 760·1) (33·8 to 38·3)* (8·5 to 11·7)* (−0·1 to 1·9) (−5·4 to −3·1)*
Alcohol dependence 107 118·2 52 397·0 10 701·5 36·0% 10·1% 0·9% −4·3%
(95 586·5 to 119 383·0) (45 967·6 to 59 241·9) (7361·4 to 14 747·1) (33·8 to 38·4)* (8·5 to 11·7)* (−0·1 to 2·0) (−5·4 to −3·1)*
Fetal alcohol syndrome 302·0 9·1 11·1 2·5% −4·7% −17·6% −14·7%
(240·9 to 370·5) (7·5 to 11·1) (6·6 to 17·0) (−3·2 to 7·2) (−10·1 to −0·2)* (−22·1 to −13·9)* (−19·4 to −10·6)*
Drug use disorders 71 244·4 7693·4 20 340·3 33·3% 20·4% 3·1% 7·1%
(63 963·8 to 79 771·6) (6880·2 to 8628·5) (14 276·7 to (30·3 to 36·3)* (17·4 to 23·6)* (1·3 to 4·8)* (4·3 to 9·9)*
26 665·5)
Opioid use disorders 40 484·6 4085·2 16 844·7 38·4% 23·7% 6·2% 9·3%
(34 271·4 to 47 941·6) (3463·6 to 4794·2) (11 549·8 to (35·4 to 41·9)* (20·2 to 27·2)* (4·5 to 8·2)* (6·0 to 12·5)*
22 534·5)
Cocaine use disorders 5017·2 260·3 680·0 24·7% 12·6% −4·7% 0·3%
(4521·0 to 5610·4) (227·9 to 301·6) (446·1 to 974·8) (21·2 to 28·6)* (11·0 to 14·4)* (−6·9 to −2·1)* (−1·2 to 2·0)
Amphetamine use disorders 7382·6 887·2 977·5 5·8% 2·7% −13·8% −4·0%
(5376·5 to 9821·8) (666·2 to 1170·2) (560·1 to 1537·4) (1·9 to 10·9)* (−0·4 to 5·7) (−16·6 to −10·4)* (−6·8 to −1·5)*
Cannabis use disorders 17 857·3 2460·7 517·7 23·8% 4·4% −2·2% −3·7%
(14 597·9 to 21 953·6) (2061·0 to 3022·0) (329·1 to 765·6) (19·7 to 28·5)* (2·2 to 6·6)* (−4·7 to 0·6) (−5·7 to −1·7)*
Other drug use disorders 2237·7 ·· 1320·5 16·8% 8·2% −8·3% −1·9%
(1984·3 to 2509·6) (888·2 to 1854·3) (12·0 to 22·4)* (5·2 to 11·2)* (−11·3 to −4·9)* (−4·3 to 0·6)
Diabetes and kidney 1 011 116·6 43 444·6 45 884·4 68·4% 29·1% 15·4% 3·2%
diseases (962 767·9 to (40 700·3 to 46 375·6) (32 018·9 to (66·5 to 70·4)* (24·8 to 34·0)* (14·2 to 16·7)* (−0·4 to 6·9)
1 065 061·5) 62 235·3)
Diabetes mellitus 475 995·8 22 935·6 38 575·4 75·9% 30·1% 20·3% 3·9%
(436 590·5 to 522 782·8) (21 082·9 to 25 040·9) (26 083·6 to (73·5 to 78·3)* (25·0 to 35·8)* (18·8 to 21·9)* (−0·1 to 8·3)
53 398·2)
Type 1 diabetes mellitus 13 019·0 400·3 964·3 40·6% 15·1% 3·5% −1·2%
(11 698·8 to 14 614·6) (362·3 to 441·7) (659·9 to 1356·0) (38·2 to 43·1)* (13·8 to 16·7)* (2·0 to 4·9)* (−2·3 to −0·1)*
Uncomplicated type 1 8762·6 400·3 412·4 34·7% 11·9% 3·5% −1·2%
diabetes mellitus (7743·9 to 9877·9) (362·3 to 441·7) (256·1 to 601·4) (32·1 to 37·3)* (10·1 to 13·6)* (1·8 to 5·1)* (−2·7 to 0·1)
Vision loss due to type 1 82·5 ·· 6·9 61·4% 4·0% 10·4% −15·1%
diabetes mellitus (65·3 to 102·7) (4·5 to 10·1) (56·5 to 66·9)* (−0·9 to 9·0) (7·4 to 14·1)* (−19·2 to −11·1)*
retinopathy
Diabetic neuropathy due 4173·9 ·· 545·0 45·4% 17·9% 3·3% −1·0%
to type 1 diabetes mellitus (3612·2 to 4837·5) (365·7 to 762·7) (42·2 to 48·6)* (15·2 to 20·7)* (1·4 to 5·3)* (−3·3 to 1·2)
Type 2 diabetes mellitus 462 976·9 22 535·3 37 611·1 77·2% 30·5% 20·9% 4·0%
(423 591·9 to 509 485·3) (20 693·8 to 24 626·7) (25 451·4 to (74·7 to 79·8)* (25·3 to 36·4)* (19·3 to 22·5)* (−0·1 to 8·6)
52 049·5)
Uncomplicated type 2 263 762·9 22 535·3 12 152·7 74·0% 28·5% 20·6% 4·0%
diabetes mellitus (232 967·8 to 297 029·0) (20 693·8 to 24 626·7) (7658·0 to 17 914·1) (70·9 to 77·3)* (22·8 to 34·5)* (18·5 to 22·8)* (−0·7 to 8·9)
Vision loss due to type 2 4509·0 ·· 362·5 97·1% 21·1% 31·3% −5·7%
diabetes mellitus (3835·7 to 5282·0) (252·6 to 500·2) (90·5 to 104·5)* (18·2 to 23·6)* (27·0 to 36·3)* (−7·7 to −3·8)*
retinopathy
Diabetic neuropathy due 194 704·9 ·· 25 095·9 78·5% 31·6% 20·9% 4·2%
to type 2 diabetes mellitus (169 971·1 to 224 314·8) (16 801·1 to (75·0 to 82·2)* (25·7 to 38·1)* (18·6 to 23·3)* (−0·4 to 9·2)
34 866·6)
Chronic kidney disease 697 509·5 19 735·6 7306·3 38·8% 24·4% −4·1% −0·2%
(649 209·4 to 752 050·7) (17 726·6 to 21 982·7) (5434·9 to 9214·6) (35·2 to 42·7)* (19·7 to 29·5)* (−6·9 to −1·3)* (−3·8 to 3·8)
Chronic kidney disease due 3246·5 118·3 264·7 58·2% 21·7% 10·3% 0·3%
to type 1 diabetes mellitus (2916·0 to 3615·5) (100·5 to 141·5) (187·5 to 353·0) (52·8 to 63·9)* (17·4 to 26·3)* (6·8 to 14·0)* (−3·0 to 3·7)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Albuminuria with 1406·8 ·· ·· ·· ·· ·· ··
preserved GFR due to (1223·8 to 1605·5)
type 1 diabetes mellitus
End-stage chronic kidney 412·3 ·· 168·0 67·5% 22·1% 13·8% −0·2%
disease due to type 1 (326·6 to 512·2) (110·5 to 233·7) (60·5 to 75·9)* (16·5 to 27·4)* (8·8 to 19·2)* (−4·4 to 3·9)
diabetes mellitus
Stage III chronic kidney 1186·3 118·3 22·8 12·2% 14·8% −13·6% 0·4%
disease due to type 1 (1002·9 to 1413·2) (100·5 to 141·5) (15·1 to 33·1) (5·2 to 23·4)* (5·8 to 24·0)* (−18·6 to −5·9)* (−7·6 to 8·5)
diabetes mellitus
Stage IV chronic kidney 149·4 ·· 20·5 54·8% 25·6% 7·4% 1·6%
diabetes mellitus
Stage V chronic kidney 91·7 ·· 53·5 61·3% 22·1% 14·7% 1·5%
diabetes mellitus
Chronic kidney disease due 125 811·6 2352·5 1450·3 49·9% 29·6% 0·7% −0·5%
to type 2 diabetes mellitus (116 308·7 to 135 941·1) (2063·9 to 2680·9) (1080·6 to 1875·1) (41·4 to 55·6)* (23·0 to 35·6)* (−3·5 to 4·3) (−5·2 to 4·0)
Albuminuria with 85 416·5 ·· ·· ·· ·· ·· ··
preserved GFR due to (76 825·4 to 94 433·7)
type 2 diabetes mellitus
End-stage chronic kidney 1046·2 ·· 432·3 94·0% 32·2% 31·7% 0·8%
diabetes mellitus
Stage III chronic kidney 35 357·3 2352·5 156·1 10·9% 19·0% −26·2% −8·1%
disease due to type 2 (31 403·1 to 39 849·1) (2063·9 to 2680·9) (102·1 to 234·4) (5·6 to 17·2)* (10·9 to 27·0)* (−29·6 to −22·1)* (−14·2 to −1·9)*
diabetes mellitus
Stage IV chronic kidney 2906·1 ·· 308·5 37·1% 30·5% −9·4% −0·8%
disease due to type 2 (2314·3 to 3621·8) (198·6 to 443·0) (31·0 to 41·1)* (21·2 to 40·3)* (−11·7 to −7·4)* (−7·6 to 6·7)
diabetes mellitus
disease due to type 2 (915·0 to 1281·7) (383·2 to 745·7) (30·4 to 55·4)* (19·5 to 39·2)* (−7·0 to 4·8) (−6·6 to 7·8)
diabetes mellitus
Chronic kidney disease due 23 605·4 911·2 1390·7 47·7% 28·0% 0·8% 1·4%
to hypertension (21 734·7 to 25 994·1) (810·0 to 1033·5) (1036·0 to 1772·1) (44·0 to 52·1)* (23·0 to 33·1)* (−1·7 to 3·7) (−2·4 to 5·4)
hypertension
disease due to (700·2 to 968·4) (232·8 to 450·8) (70·5 to 86·4)* (28·9 to 37·6)* (15·4 to 25·5)* (−0·7 to 5·4)
hypertension
disease due to (13 086·5 to 16 401·2) (810·0 to 1033·5) (81·8 to 181·1) (10·7 to 22·4)* (9·1 to 23·6)* (−26·2 to −18·7)* (−14·9 to −3·8)*
hypertension
Stage IV chronic kidney 2743·0 ·· 299·7 39·4% 29·0% −7·1% 0·4%
disease due to (2268·8 to 3328·2) (200·7 to 418·4) (36·2 to 42·9)* (20·5 to 37·3)* (−8·7 to −5·1)* (−5·9 to 6·7)
hypertension
hypertension
Chronic kidney disease due 28 809·4 1509·5 1047·9 38·1% 20·4% 0·8% 2·2%
to glomerulonephritis (26 470·2 to 31 575·8) (1345·4 to 1699·8) (753·5 to 1372·2) (34·5 to 43·1)* (15·5 to 25·6)* (−1·4 to 3·8) (−1·8 to 6·8)
glomerulonephritis
End-stage chronic kidney 691·9 ·· 270·4 57·3% 22·7% 10·2% −0·4%
glomerulonephritis


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
disease due to (18 673·1 to 23 071·0) (1345·4 to 1699·8) (55·6 to 125·3) (1·1 to 17·8)* (0·1 to 16·9)* (−21·6 to −10·0)* (−12·1 to 2·5)
glomerulonephritis
disease due to (1169·9 to 1762·1) (110·5 to 246·3) (27·3 to 35·6)* (13·0 to 29·7)* (−8·3 to −3·2)* (−5·4 to 9·3)
glomerulonephritis
glomerulonephritis
Chronic kidney disease due 516 036·7 14 844·1 3152·6 30·2% 22·2% −10·3% −1·5%
to other and unspecified (480 273·8 to 555 659·4) (13 340·7 to 16 532·6) (2327·5 to 4005·4) (27·0 to 34·6)* (17·2 to 27·6)* (−13·0 to −7·3)* (−5·5 to 2·8)
causes
Albuminuria with 285 109·9 ·· ·· ·· ·· ·· ··
preserved GFR due to (256 788·7 to 314 368·4)
other and unspecified
causes
disease due to other and (822·5 to 1111·7) (257·9 to 504·2) (54·4 to 66·0)* (19·3 to 28·3)* (9·5 to 17·3)* (−3·1 to 3·2)
unspecified causes
Stage III chronic kidney 222 956·2 14 844·1 1105·1 11·4% 15·6% −24·8% −8·4%
disease due to other and (200 778·0 to 247 902·5) (13 340·7 to 16 532·6) (727·3 to 1640·7) (7·2 to 15·7)* (9·4 to 22·0)* (−27·6 to −22·1)* (−13·4 to −3·2)*
unspecified causes
disease due to other and (4024·2 to 5754·4) (346·0 to 725·0) (34·0 to 40·9)* (20·0 to 36·0)* (−9·3 to −5·9)* (−5·5 to 6·5)
unspecified causes
disease due to other and (1894·3 to 2551·5) (788·6 to 1517·9) (39·4 to 49·2)* (19·9 to 32·2)* (0·8 to 6·3)* (−0·4 to 9·7)
unspecified causes
Acute glomerulonephritis 52·4 773·4 2·6 −1·3% 1·0% −24·3% −12·6%
(45·5 to 60·7) (672·8 to 877·3) (1·6 to 4·0) (−13·9 to 2·3) (−2·1 to 3·5) (−34·2 to −21·4)* (−15·3 to −10·1)*
Skin and subcutaneous 1 974 238·4 4 185 971·3 41 621·9 24·0% 13·0% 0·9% 0·6%
diseases (1 916 671·8 to (3 971 760·5 to (27 371·7 to (22·9 to 25·3)* (12·5 to 13·6)* (0·4 to 1·4)* (0·1 to 1·1)*
2 034 645·7) 4 391 218·2) 61 859·5)
Dermatitis 291 689·4 274 034·1 11 128·1 19·3% 12·1% −0·1% 1·1%
(276 520·7 to 308 059·0) (246 120·0 to 302 497·5) (6484·1 to 17 733·4) (18·2 to 20·7)* (11·3 to 12·8)* (−0·7 to 0·5) (0·4 to 1·8)*
Atopic dermatitis 205 517·2 27 134·4 9003·4 17·0% 11·6% 0·4% 1·7%
(193 701·2 to 218 582·4) (25 282·9 to 29 055·0) (4887·0 to (16·1 to 17·9)* (10·8 to 12·5)* (−0·4 to 1·1) (0·9 to 2·6)*
14 981·0)
Contact dermatitis 79 666·7 221 252·8 1989·2 31·0% 14·4% −1·6% −1·1%
(70 425·7 to 89 554·9) (193 775·3 to 249 726·6) (1304·4 to 2950·5) (28·8 to 33·2)* (12·6 to 16·2)* (−2·3 to −1·0)* (−1·7 to −0·5)*
Seborrhoeic dermatitis 10 035·9 25 646·9 135·6 20·8% 8·4% −7·7% −7·1%
(9450·2 to 10 668·4) (23 981·6 to 27 315·9) (78·1 to 215·0) (18·5 to 23·3)* (6·6 to 10·3)* (−9·0 to −6·4)* (−8·3 to −5·8)*
Psoriasis 64 609·6 7846·6 5569·5 43·1% 21·1% 5·1% 2·3%
(62 454·3 to 66 767·5) (7564·9 to 8162·8) (3956·1 to 7354·3) (42·0 to 44·2)* (20·3 to 21·9)* (4·3 to 5·8)* (1·6 to 2·9)*
Bacterial skin diseases 11 397·9 266 779·7 177·9 29·2% 15·5% 2·0% 0·8%
(11 061·4 to 11 741·7) (260 229·3 to 273 665·3) (112·3 to 274·1) (27·2 to 31·0)* (14·0 to 17·1)* (−0·5 to 4·4) (−1·1 to 2·9)
Cellulitis 2071·5 42 958·6 118·2 26·7% 12·9% −2·6% −2·9%
(1952·2 to 2186·2) (40 535·7 to 45 172·9) (78·7 to 167·8) (24·9 to 28·6)* (11·7 to 14·2)* (−3·8 to −1·3)* (−3·8 to −2·0)*
Pyoderma 10 557·2 223 821·2 59·6 35·0% 20·9% 13·0% 8·8%
(10 245·5 to 10 853·2) (217 649·0 to 230 259·5) (23·9 to 123·5) (33·7 to 36·4)* (19·8 to 22·2)* (11·9 to 14·2)* (7·8 to 9·9)*
Impetigo 4620·7 84 007·5 26·4 35·7% 20·7% 24·1% 13·4%
(4358·2 to 4870·5) (79 485·3 to 88 529·9) (10·4 to 55·8) (33·6 to 37·8)* (18·7 to 22·7)* (22·2 to 26·0)* (11·5 to 15·2)*
Abscess and other 5936·4 139 813·6 33·2 34·5% 21·1% 5·5% 5·1%
bacterial skin diseases (5770·4 to 6098·7) (135 314·1 to 143 965·8) (13·4 to 69·5) (32·8 to 36·3)* (19·7 to 22·6)* (4·2 to 6·8)* (3·8 to 6·4)*
Scabies 175 406·7 527 476·5 4528·7 16·1% 6·6% −4·3% −3·1%
(154 517·9 to 198 404·1) (462 050·9 to 598 087·9) (2506·4 to 7414·6) (13·8 to 18·5)* (5·3 to 8·0)* (−5·0 to −3·6)* (−3·6 to −2·6)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Fungal skin diseases 743 458·4 2 126 927·9 4154·5 21·5% 10·9% −3·1% −4·4%
(681 568·4 to 808 149·7) (1 917 361·6 to (1651·4 to 8633·2) (19·0 to 24·0)* (9·2 to 12·5)* (−3·8 to −2·4)* (−5·4 to −3·4)*
2 317 274·7)
Tinea capitis 160 239·3 303 016·6 916·5 −5·8% −13·0% −13·8% −19·0%
(133 390·6 to 194 439·3) (245 340·4 to 369 760·2) (357·3 to 1965·4) (−7·3 to −4·3)* (−14·5 to −11·3)* (−15·0 to −12·7)* (−20·4 to −17·3)*
Other fungal skin diseases 583 219·1 1 823 911·3 3238·0 37·1% 20·2% 1·8% 1·3%
(526 500·8 to 645 363·9) (1 638 297·9 to (1305·4 to 6694·4) (35·2 to 39·3)* (19·0 to 21·6)* (1·5 to 2·1)* (1·1 to 1·5)*
2 009 788·9)
Viral skin diseases 130 639·2 116 329·8 4033·0 10·4% 6·4% −2·8% −1·8%
(125 604·0 to 136 047·9) (111 012·4 to 121 710·1) (2595·4 to 5995·6) (9·8 to 11·1)* (6·0 to 6·9)* (−3·2 to −2·3)* (−2·2 to −1·4)*
Viral warts 54 309·6 30 140·5 1662·2 13·7% 5·6% −6·8% −4·8%
(52 104·2 to 56 403·2) (29 078·5 to 31 211·0) (1066·0 to 2439·8) (12·8 to 14·6)* (4·8 to 6·3)* (−7·3 to −6·3)* (−5·4 to −4·3)*
Molluscum contagiosum 76 329·6 86 189·3 2370·7 8·2% 7·1% 0·2% 0·3%
(71 596·6 to 81 134·1) (80 984·6 to 91 427·2) (1511·7 to 3525·9) (7·5 to 8·9)* (6·5 to 7·6)* (−0·3 to 0·8) (−0·3 to 0·8)
Acne vulgaris 119 082·3 60 118·8 2547·6 46·1% 16·2% 19·8% 11·4%
(107 127·9 to 133 651·4) (53 260·2 to 68 180·7) (1518·8 to 4056·6) (44·6 to 47·6)* (15·2 to 17·2)* (18·6 to 20·9)* (10·3 to 12·5)*
Alopecia areata 15 981·0 28 185·2 523·1 28·8% 12·7% −2·3% −1·5%
(15 477·3 to 16 515·9) (27 302·2 to 29 126·3) (334·9 to 774·8) (27·6 to 30·1)* (11·8 to 13·8)* (−3·1 to −1·4)* (−2·3 to −0·6)*
Pruritus 71 224·3 55 643·1 755·6 36·4% 18·9% 2·9% 1·6%
(63 948·2 to 80 034·2) (49 208·3 to 62 689·4) (356·1 to 1433·2) (34·1 to 38·8)* (17·5 to 20·4)* (2·5 to 3·4)* (1·2 to 2·0)*
Urticaria 83 610·0 147 198·5 5014·8 19·3% 10·8% 0·7% 0·3%
(73 335·4 to 95 162·9) (129 941·2 to 166 345·6) (3321·0 to 7046·4) (17·4 to 21·5)* (9·8 to 11·9)* (0·2 to 1·2)* (−0·2 to 0·8)
Decubitus ulcer 1143·7 4199·3 181·2 45·2% 28·9% −3·3% −0·4%
(1022·6 to 1288·5) (3752·4 to 4741·3) (125·8 to 244·3) (42·7 to 47·7)* (26·3 to 31·9)* (−4·9 to −1·8)* (−2·2 to 1·5)
Other skin and subcutaneous 550 810·3 571 231·9 3008·1 45·1% 25·6% 6·6% 4·3%
diseases (538 490·7 to 563 961·3) (558 726·3 to 584 649·5) (1446·7 to 5557·4) (44·6 to 45·6)* (25·2 to 26·0)* (6·4 to 6·8)* (4·1 to 4·5)*
Sense organ diseases 2 035 737·0 ·· 66 576·1 42·0% 24·1% −1·0% −0·9%
(1 994 115·8 to (44 700·8 to (41·1 to 42·8)* (23·4 to 24·8)* (−1·6 to −0·5)* (−1·5 to −0·3)*
2 079 908·6) 95 675·1)
Blindness and vision 1 193 642·8 ·· 29 895·2 39·3% 23·1% −2·7% −1·8%
impairment (1 154 777·0 to 1 237 118·0) (20 277·7 to (37·8 to 40·5)* (22·0 to 24·0)* (−3·5 to −1·9)* (−2·7 to −0·9)*
44 036·0)
Glaucoma 5993·5 ·· 686·1 41·5% 27·9% −6·0% −4·7%
(5157·5 to 6984·8) (462·9 to 948·8) (39·1 to 44·2)* (26·4 to 29·4)* (−7·4 to −4·2)* (−5·8 to −3·6)*
Cataract 107 987·7 ·· 8005·8 49·4% 29·6% −2·8% −2·0%
(95 775·3 to 122 319·3) (5579·2 to 10 820·9) (46·9 to 52·0)* (27·4 to 31·7)* (−4·2 to −1·2)* (−3·6 to −0·5)*
Age-related macular 6758·8 ·· 530·7 59·3% 30·7% 2·8% −3·7%
degeneration (5612·6 to 8183·0) (363·6 to 728·6) (54·5 to 63·9)* (28·6 to 32·9)* (−0·7 to 6·1) (−5·3 to −2·1)*
Refraction disorders 185 392·8 ·· 7984·3 24·6% 15·3% −6·1% −3·1%
(165 673·9 to 208 575·2) (5353·0 to 11 487·0) (21·7 to 27·7)* (13·6 to 17·0)* (−7·8 to −4·3)* (−4·2 to −1·9)*
Near vision loss 969 669·5 ·· 9802·9 46·4% 24·6% 1·2% 0·5%
(932 613·8 to 1 009 067·7) (4669·6 to 17 922·5) (45·6 to 47·1)* (24·0 to 25·2)* (0·8 to 1·7)* (0·1 to 0·9)*
Other vision loss 34 607·5 ·· 2885·3 36·7% 21·0% −4·6% −3·7%
(30 956·5 to 38 397·4) (2013·7 to 3884·0) (34·6 to 38·8)* (19·4 to 22·6)* (−5·8 to −3·3)* (−4·8 to −2·6)*
Age-related and other 1 317 431·7 ·· 34 229·6 44·4% 24·9% 0·4% −0·2%
hearing loss (1 276 962·6 to (23 176·8 to (43·0 to 45·7)* (23·9 to 26·0)* (−0·4 to 1·1) (−1·0 to 0·5)
1 356 229·1) 48 684·1)
Other sense organ diseases 103 750·5 ·· 2451·3 42·1% 25·0% 1·8% 0·9%
(100 613·2 to 107 050·4) (1519·6 to 3573·5) (41·1 to 43·1)* (24·2 to 25·8)* (1·3 to 2·3)* (0·4 to 1·4)*
Chronic other sense organ 87 788·5 ·· 2232·4 44·3% 26·1% 1·8% 0·9%
diseases (84 748·6 to 91 039·5) (1381·5 to 3246·2) (43·4 to 45·3)* (25·4 to 26·9)* (1·3 to 2·3)* (0·4 to 1·4)*
Acute other sense organ 15 962·1 ·· 218·9 24·3% 14·6% 1·7% 1·0%
diseases (15 501·3 to 16 458·6) (133·2 to 332·7) (22·6 to 25·9)* (13·2 to 16·2)* (0·5 to 2·9)* (−0·3 to 2·4)


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Musculoskeletal disorders 1 312 131·3 334 744·9 135 881·3 38·4% 19·9% −2·3% −1·1%
(1 248 058·7 to (309 934·0 to (99 022·6 to (36·4 to 40·2)* (18·8 to 21·2)* (−3·3 to −1·2)* (−1·7 to −0·5)*
1 383 422·6) 363 175·8) 179 645·0)
Rheumatoid arthritis 19 965·1 1204·6 2626·0 45·8% 33·5% 0·9% 6·7%
(17 990·5 to 21 955·7) (1071·1 to 1331·7) (1783·4 to 3529·9) (44·1 to 47·5)* (30·6 to 36·4)* (−0·1 to 1·9) (4·7 to 8·8)*
Osteoarthritis 303 096·5 14 933·5 9604·0 63·1% 31·4% 8·5% 1·0%
(273 279·8 to 338 632·0) (13 386·3 to 16 739·6) (4808·6 to (61·5 to 64·9)* (30·7 to 32·1)* (7·5 to 9·6)* (0·5 to 1·6)*
19 139·0)
Osteoarthritis of the hip 40 010·0 2045·1 1265·4 59·1% 35·3% 5·7% 3·8%
(37 473·8 to 42 725·7) (1913·7 to 2195·9) (648·2 to 2609·3) (57·9 to 60·4)* (34·5 to 36·2)* (4·9 to 6·4)* (3·2 to 4·4)*
Osteoarthritis of the knee 263 086·5 12 888·4 8338·6 63·7% 30·8% 9·0% 0·6%
(232 661·9 to 298 640·0) (11 375·0 to 14 656·0) (4152·3 to 16 431·9) (61·8 to 65·8)* (30·1 to 31·6)* (7·7 to 10·3)* (0·1 to 1·2)*
Low back pain 576 980·9 245 858·9 64 946·7 30·0% 17·5% −7·2% −2·1%
(518 940·4 to 637 177·9) (221 816·5 to 272 419·6) (46 512·3 to (27·9 to 31·9)* (16·2 to 19·0)* (−8·4 to −6·0)* (−2·6 to −1·6)*
87 417·1)
Low back pain with leg pain 187 103·9 78 640·7 26 843·2 31·2% 19·0% −7·8% −2·2%
(167 946·8 to 209 695·8) (69 782·0 to 87 714·4) (19 173·1 to (29·0 to 33·4)* (17·6 to 20·6)* (−8·9 to −6·5)* (−2·7 to −1·6)*
36 078·7)
Low back pain without leg 389 877·0 167 218·2 38 103·5 29·1% 16·5% −6·9% −2·0%
pain (350 624·1 to 429 901·0) (150 726·4 to 185 159·5) (27 216·0 to (27·1 to 31·1)* (15·1 to 18·0)* (−8·1 to −5·7)* (−2·5 to −1·6)*
51 524·8)
Neck pain 288 718·6 65 310·3 28 631·1 44·4% 21·4% −0·0% −0·7%
(254 715·3 to 323 483·0) (57 678·2 to 73 917·2) (19 951·8 to (41·9 to 47·0)* (19·5 to 23·6)* (−1·2 to 1·2) (−1·6 to 0·5)
40 202·3)
Gout 41 217·7 7437·7 1285·0 54·7% 30·9% 4·4% 2·7%
(36 699·8 to 46 101·3) (6573·8 to 8457·4) (867·4 to 1768·9) (52·5 to 56·9)* (29·2 to 32·6)* (3·1 to 5·8)* (1·6 to 3·7)*
Other musculoskeletal 336 467·8 ·· 28 788·6 46·1% 19·0% 4·3% −0·8%
disorders (285 415·0 to 383 783·9) (19 498·0 to (43·6 to 48·6)* (15·5 to 22·4)* (3·3 to 5·4)* (−3·3 to 1·4)
39 995·7)
Other non-communicable 4 916 184·8 4 209 631·0 53 645·9 25·7% 12·9% −5·3% −3·2%
diseases (4 793 498·0 to (3 838 652·6 to (36 899·7 to (24·2 to 27·5)* (11·8 to 14·2)* (−6·0 to −4·6)* (−3·9 to −2·4)*
5 046 526·7) 4 611 876·0) 74 479·3)
Congenital anomalies 100 366·3 5445·3 12 056·9 23·1% 12·7% −0·1% 0·8%
(95 153·7 to 106 524·9) (5088·8 to 5844·4) (8552·1 to (22·0 to 24·2)* (11·7 to 13·7)* (−0·9 to 0·8) (−0·2 to 1·6)
16 062·8)
Neural tube defects 2874·4 163·9 854·7 25·1% 17·0% 2·1% 5·1%
(2566·3 to 3205·2) (145·4 to 185·1) (600·1 to 1133·9) (22·7 to 27·5)* (13·8 to 20·3)* (0·2 to 4·1)* (2·2 to 8·0)*
Severe motor and 0·1 12·8 0·0 −5·3% −6·5% −4·5% −8·9%
cognitive impairment (0·1 to 0·1) (10·2 to 16·3) (0·0 to 0·1) (−7·2 to −3·3)* (−8·6 to −4·5)* (−6·4 to −2·4)* (−11·0 to −7·0)*
due to anencephaly
Encephalocoele due to 300·6 28·8 51·8 17·0% 12·8% −6·3% −0·7%
neural tube defects (246·9 to 354·9) (22·3 to 37·4) (34·6 to 72·3) (14·3 to 20·0)* (9·8 to 15·6)* (−8·1 to −4·4)* (−3·4 to 1·9)
Spina bifida due to neural 2573·8 122·3 802·9 25·7% 17·3% 2·8% 5·5%
tube defects (2296·6 to 2874·9) (106·0 to 141·4) (557·1 to 1069·3) (23·1 to 28·3)* (14·1 to 20·6)* (0·7 to 4·8)* (2·6 to 8·5)*
Congenital heart anomalies 11 998·3 2481·7 589·5 12·2% 7·6% 1·9% 0·2%
(10 958·7 to 13 123·9) (2203·2 to 2775·4) (287·2 to 973·4) (9·7 to 13·9)* (5·7 to 9·1)* (0·4 to 3·2)* (−1·5 to 1·5)
Critical malformations of 2075·2 519·5 124·7 10·0% 6·9% 0·9% −0·1%
great vessels, congenital (1788·4 to 2407·9) (406·2 to 650·6) (62·7 to 201·6) (7·1 to 12·6)* (4·3 to 9·1)* (−1·5 to 2·9) (−2·3 to 2·1)
valvular heart disease, and
patent ductus arteriosus
Other congenital heart 2540·8 398·3 142·9 14·2% 8·9% 1·5% 0·4%
anomalies (2333·1 to 2769·7) (353·7 to 445·6) (62·3 to 243·7) (11·1 to 16·6)* (6·5 to 11·1)* (−0·6 to 3·5) (−1·8 to 2·4)
Severe congenital heart 2899·7 565·8 170·9 20·6% 9·2% 6·5% 0·7%
anomalies excluding single (2567·0 to 3266·8) (453·1 to 699·6) (86·1 to 282·1) (17·0 to 23·4)* (6·5 to 11·6)* (4·1 to 8·7)* (−1·7 to 3·0)
ventricle heart defects


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Single ventricle and single 344·0 263·5 21·1 13·0% 7·2% 5·5% 0·8%
ventricle pathway (285·0 to 413·7) (186·1 to 356·8) (11·3 to 33·7) (9·0 to 17·2)* (3·2 to 11·1)* (1·8 to 9·4)* (−3·1 to 4·6)
congenital heart
anomalies
Ventricular septal defect 4138·6 734·5 129·8 2·9% 5·1% −2·4% −0·7%
and atrial septal defect (3401·3 to 4864·5) (588·6 to 908·7) (62·0 to 225·5) (−0·0 to 5·7) (2·5 to 7·5)* (−4·7 to −0·0)* (−3·3 to 1·6)
Orofacial clefts 10 816·4 195·5 320·8 8·7% 13·5% −11·2% 1·5%
(9945·7 to 11 654·1) (152·0 to 249·3) (211·9 to 468·2) (3·4 to 14·7)* (7·5 to 20·0)* (−15·5 to −6·4)* (−4·0 to 7·3)
Down syndrome 3535·7 110·5 326·4 22·5% 11·8% −1·5% −0·2%
(3092·1 to 4015·5) (95·2 to 130·6) (222·7 to 452·6) (21·3 to 23·8)* (9·1 to 14·7)* (−2·6 to −0·5)* (−2·6 to 2·4)
Turner syndrome 572·3 19·6 10·1 21·6% 9·1% 1·1% 0·9%
(502·0 to 652·8) (17·0 to 22·9) (5·0 to 16·5) (19·5 to 24·1)* (7·3 to 10·9)* (−0·6 to 2·7) (−0·7 to 2·5)
Klinefelter syndrome 866·8 28·3 5·2 28·6% 7·4% 4·4% −1·7%
(747·4 to 994·2) (24·2 to 32·8) (2·4 to 9·7) (24·5 to 33·0)* (4·3 to 10·7)* (1·4 to 7·6)* (−4·5 to 1·1)
Other chromosomal 6379·1 301·3 593·1 24·2% 19·6% 2·3% 7·1%
abnormalities (5052·5 to 7827·4) (236·2 to 371·0) (389·9 to 833·1) (22·1 to 26·3)* (16·9 to 22·4)* (0·7 to 4·1)* (4·7 to 9·5)*
Congenital musculoskeletal 31 506·6 1537·0 4622·5 24·8% 13·4% −0·6% 0·4%
and limb anomalies (28 137·2 to 36 022·4) (1327·4 to 1777·0) (3030·7 to 6345·8) (23·9 to 25·8)* (12·5 to 14·2)* (−1·4 to 0·1) (−0·4 to 1·1)
Polydactyly and 432·6 218·7 4·7 0·3% 7·1% −4·4% 0·9%
syndactyly (342·4 to 538·9) (158·9 to 295·2) (2·1 to 9·1) (−3·9 to 5·2) (3·1 to 10·9)* (−8·1 to −0·2)* (−3·2 to 4·7)
Congenital limb 14 811·3 389·3 2217·3 22·4% 11·8% −0·1% 0·5%
deficiency (13 154·2 to 17 016·1) (343·2 to 449·2) (1452·1 to 3057·6) (21·2 to 23·6)* (10·8 to 12·9)* (−1·1 to 0·8) (−0·4 to 1·5)
Other congenital 16 262·8 929·0 2400·4 27·3% 14·8% −1·1% 0·2%
musculoskeletal anomalies (14 519·3 to 18 611·7) (801·7 to 1074·0) (1574·9 to 3296·1) (26·1 to 28·5)* (13·8 to 15·8)* (−2·1 to −0·2)* (−0·7 to 1·0)
Urogenital congenital 5725·5 249·7 141·0 13·0% 4·2% −4·7% −4·1%
anomalies (4984·9 to 6504·8) (216·9 to 285·3) (82·3 to 233·3) (11·5 to 14·6)* (2·2 to 6·3)* (−5·8 to −3·6)* (−6·0 to −2·3)*
Digestive congenital 17 662·5 357·9 794·3 16·3% 8·7% −8·5% −4·3%
anomalies (15 899·6 to 19 748·8) (323·3 to 398·8) (528·2 to 1134·1) (15·0 to 17·5)* (4·3 to 13·2)* (−9·5 to −7·5)* (−8·3 to −0·4)*
Congenital 315·6 15·5 6·2 13·9% 6·5% −1·3% −1·8%
diaphragmatic hernia (276·8 to 357·7) (12·9 to 17·9) (3·6 to 10·1) (12·9 to 14·9)* (5·6 to 7·3)* (−2·0 to −0·5)* (−2·6 to −1·0)*
Congenital atresia or 111·9 137·3 8·9 −5·9% 6·1% −7·8% 0·7%
stenosis of the digestive (83·4 to 142·7) (96·5 to 174·1) (5·4 to 13·7) (−8·5 to −3·4)* (3·2 to 9·1)* (−10·3 to −5·4)* (−2·1 to 3·6)
tract
Congenital malformations 1258·9 84·7 54·0 15·2% 7·4% 0·1% −0·8%
of the abdominal wall (1109·6 to 1431·5) (71·3 to 99·3) (34·5 to 79·4) (14·3 to 16·2)* (6·6 to 8·2)* (−0·6 to 0·8) (−1·6 to −0·1)*
after treatment
Other congenital 15 976·1 120·3 725·2 16·7% 8·8% −9·2% −4·7%
malformations of the (14 219·3 to 18 092·5) (88·9 to 169·7) (480·5 to 1035·6) (15·2 to 18·2)* (4·0 to 13·7)* (−10·3 to −8·1)* (−9·0 to −0·4)*
digestive tract
Other congenital anomalies 25 911·9 ·· 3799·4 25·9% 12·1% 2·9% 0·8%
(22 431·7 to 30 006·9) (2595·5 to 5226·3) (23·0 to 28·7)* (9·6 to 14·5)* (0·5 to 5·3)* (−1·4 to 3·0)
Other congenital birth ·· ·· 446·4 34·8% 19·3% 19·0% 9·8%
defects (309·1 to 601·8) (32·6 to 37·3)* (17·3 to 22·0)* (17·6 to 20·5)* (8·0 to 11·9)*
Hearing loss due to other 25 911·9 ·· 3353·0 24·8% 11·2% 1·1% −0·4%
congenital anomalies (22 431·7 to 30 006·9) (2227·2 to 4697·0) (21·6 to 28·0)* (8·4 to 13·9)* (−1·4 to 3·6) (−2·8 to 2·1)
Urinary diseases and male 110 267·4 366 721·5 3135·6 33·7% 26·9% −7·6% −0·8%
infertility (99 363·2 to 120 483·9) (337 838·9 to 396 838·4) (2053·6 to 4529·0) (31·9 to 35·6)* (25·5 to 28·4)* (−9·0 to −6·2)* (−1·7 to 0·1)
Urinary tract infections 5250·9 274 626·5 173·0 29·8% 16·6% 0·3% 1·9%
(4741·8 to 5801·2) (247 558·6 to 303 427·3) (106·4 to 256·5) (27·1 to 32·4)* (14·0 to 19·3)* (−1·2 to 1·9) (0·1 to 3·7)*
Urolithiasis 3147·5 83 173·6 230·9 31·2% 18·6% −7·5% −2·0%
(2808·1 to 3483·6) (74 603·1 to 91 918·7) (159·6 to 317·0) (28·7 to 34·1)* (16·2 to 20·9)* (−9·3 to −5·7)* (−3·5 to −0·3)*
Benign prostatic 74 541·9 8921·5 2427·3 36·7% 32·0% −8·0% −0·2%
hyperplasia (65 358·9 to 84 081·8) (7859·8 to 10 046·2) (1562·8 to 3460·0) (34·1 to 39·5)* (30·7 to 33·3)* (−9·5 to −6·2)* (−1·1 to 0·8)
Male infertility 30 432·7 ·· 180·9 33·1% 17·0% 1·3% 6·9%
(24 686·0 to 36 812·7) (74·8 to 373·9) (29·7 to 36·8)* (13·7 to 20·1)* (−0·5 to 3·3) (4·1 to 9·7)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Other urinary diseases ·· ·· 123·5 8·4% −7·1% −18·0% −20·3%
(84·7 to 170·6) (6·5 to 10·3)* (−8·6 to −5·7)* (−19·3 to −16·7)* (−21·5 to −19·2)*
Gynaecological diseases 815 073·8 195 631·4 11 619·6 33·9% 10·2% −1·9% −2·4%
(787 646·5 to 843 595·7) (189 141·1 to 202 275·1) (7966·6 to 16 279·1) (31·3 to 36·5)* (9·0 to 11·6)* (−3·4 to −0·5)* (−3·3 to −1·4)*
Uterine fibroids 159 444·4 8445·5 1473·4 44·3% 8·1% −2·5% −8·0%
(139 576·9 to 182 588·5) (7062·0 to 10 077·7) (866·6 to 2386·3) (39·5 to 48·4)* (3·9 to 11·7)* (−5·7 to 0·4) (−11·5 to −5·1)*
Polycystic ovarian 52 159·9 2129·0 459·4 33·2% 13·1% 0·6% 1·8%
syndrome (41 652·7 to 66 540·8) (1727·3 to 2716·3) (203·7 to 886·2) (31·8 to 34·6)* (12·1 to 14·1)* (−0·3 to 1·4) (1·0 to 2·7)*
Female infertility 61 238·4 ·· 342·6 32·1% 27·5% −0·0% 16·5%
(43 321·2 to 82 668·2) (129·5 to 723·4) (26·8 to 37·5)* (22·2 to 32·7)* (−2·6 to 2·7) (12·0 to 20·8)*
Endometriosis 44 656·0 6291·6 4121·5 31·2% 9·2% −3·1% −3·0%
(37 289·1 to 52 852·4) (5083·7 to 7555·2) (2752·3 to 5940·5) (26·0 to 37·5)* (7·9 to 10·5)* (−6·3 to 0·5) (−3·9 to −2·0)*
Genital prolapse 108 559·4 12 319·0 337·3 26·0% 19·9% −13·7% −3·6%
(96 272·0 to 121 882·8) (10 947·3 to 13 860·3) (161·9 to 634·2) (25·0 to 27·2)* (18·5 to 21·3)* (−14·4 to −12·9)* (−4·4 to −2·8)*
Premenstrual syndrome 472 189·7 127 157·4 3930·0 32·3% 8·8% −0·6% −2·2%
(451 411·0 to 493 266·2) (121 707·4 to 132 919·3) (2533·7 to 5900·3) (30·9 to 33·7)* (7·2 to 10·1)* (−1·4 to 0·3) (−3·6 to −1·0)*
Other gynaecological 50 421·8 39 288·9 955·4 42·2% 14·5% 3·0% 1·3%
diseases (48 042·0 to 52 824·5) (37 076·3 to 41 538·6) (643·6 to 1384·7) (36·5 to 47·7)* (11·6 to 17·4)* (−0·6 to 6·7) (−1·5 to 3·9)
Other gynaecological 45 859·4 39 288·9 855·8 41·5% 15·5% 2·5% 1·9%
diseases (43 492·6 to 48 226·9) (37 076·3 to 41 538·6) (576·7 to 1238·9) (35·6 to 47·2)* (12·2 to 18·6)* (−1·2 to 6·4) (−1·1 to 5·0)
Other gynaecological 4562·4 ·· 99·6 47·3% 6·6% 6·4% −4·2%
diseases with anaemia (4423·1 to 4703·7) (66·3 to 146·8) (39·9 to 55·6)* (1·1 to 11·8)* (0·9 to 12·5)* (−8·9 to 0·6)
Haemoglobinopathies and 1 922 603·3 42 237·7 5313·7 1·1% −5·3% −17·8% −15·2%
haemolytic anaemias (1 878 676·9 to (40 961·6 to 43 660·7) (3608·1 to 7683·0) (−2·0 to 4·1) (−8·4 to −2·3)* (−20·2 to −15·5)* (−17·9 to −12·5)*
1 967 411·4)
Thalassaemias 411·4 106·3 17·2 −38·9% −20·0% −41·0% −24·4%
(384·1 to 441·7) (99·7 to 113·5) (11·4 to 25·3) (−42·9 to −34·6)* (−25·4 to −15·4)* (−44·8 to −36·6)* (−29·6 to −20·0)*
Thalassaemias trait 298 566·6 4868·2 1908·8 −8·2% −12·1% −25·7% −21·6%
(287 549·2 to 309 863·6) (4697·5 to 5051·2) (1282·8 to 2781·8) (−12·8 to −3·6)* (−16·1 to −7·7)* (−29·1 to −22·1)* (−25·1 to −18·0)*
Sickle cell disorders 3131·7 613·1 252·7 42·0% 15·1% 28·0% 8·4%
(2845·5 to 3434·9) (514·6 to 732·0) (173·0 to 354·4) (34·4 to 50·4)* (8·0 to 21·2)* (21·0 to 35·3)* (1·8 to 14·2)*
Sickle cell trait 460 730·8 10 822·4 1203·4 20·5% −1·3% 1·2% −10·3%
(416 642·3 to 511 272·8) (9887·9 to 11 861·3) (812·3 to 1731·4) (16·4 to 24·3)* (−5·1 to 2·9) (−1·9 to 4·2) (−13·9 to −6·4)*
G6PD deficiency 359 180·8 7844·9 24·7 13·8% 2·3% −6·9% −8·8%
(344 591·4 to 374 393·5) (7507·8 to 8199·3) (17·1 to 34·4) (8·1 to 21·1)* (−4·6 to 8·7) (−11·5 to −1·1)* (−15·2 to −3·1)*
G6PD trait 940 308·4 17 982·7 0·4 28·3% 3·0% 1·3% −8·1%
(924 830·5 to 955 818·2) (17 673·9 to 18 299·5) (0·3 to 0·6) (22·4 to 34·0)* (−1·7 to 7·8) (−3·2 to 5·7) (−12·2 to −3·9)*
Other 79 442·9 ·· 1906·4 −0·4% −2·5% −20·8% −13·8%
haemoglobinopathies and (77 864·8 to 81 099·0) (1289·0 to 2768·5) (−3·3 to 2·5) (−5·8 to 1·0) (−23·0 to −18·7)* (−16·8 to −10·6)*
haemolytic anaemias
Endocrine, metabolic, blood, 109 922·2 ·· 3215·7 6·1% 3·2% −16·0% −9·5%
and immune disorders (106 937·4 to 113 100·4) (2232·5 to 4501·4) (4·1 to 8·2)* (1·0 to 5·4)* (−17·4 to −14·5)* (−11·4 to −7·4)*
Anaemia due to endocrine, 81 387·3 ·· 2177·1 0·0% −4·9% −19·4% −14·3%
metabolic, blood, and (80 146·9 to 82 729·4) (1481·4 to 3130·1) (−2·5 to 2·6) (−8·1 to −1·5)* (−21·4 to −17·4)* (−17·2 to −11·3)*
immune disorders
Endocrine, metabolic, blood, 28 144·8 ·· 1005·7 27·2% 25·4% −5·4% 3·3%
and immune disorders (25 572·5 to 30 946·4) (684·2 to 1398·9) (24·6 to 30·0)* (22·2 to 28·7)* (−6·6 to −4·0)* (1·0 to 5·5)*
endocrine, metabolic, blood, (322·2 to 465·9) (21·8 to 46·4) (27·5 to 40·8)* (24·7 to 31·5)* (−18·2 to −9·7)* (−6·9 to −2·1)*
and immune disorders
Oral disorders 3 466 894·0 3 599 595·0 18 304·4 38·4% 21·4% −2·7% −1·3%
(3 271 733·1 to (3 233 032·9 to (10 992·8 to (36·9 to 39·8)* (20·5 to 22·3)* (−3·8 to −1·8)* (−2·0 to −0·6)*
3 676 485·6) 3 992 824·0) 28 338·1)
Caries of deciduous teeth 531 801·7 1 057 534·3 138·9 −4·5% 4·9% −7·0% −2·1%
(443 844·0 to 622 463·7) (756 100·5 to 1 400 908·8) (59·4 to 278·1) (−6·2 to −2·9)* (3·1 to 6·3)* (−8·6 to −5·6)* (−3·7 to −0·8)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Caries of permanent teeth 2 301 999·2 2 452 124·9 1618·9 20·6% 9·4% −8·2% −4·0%
(2 104 931·2 to (2 233 639·1 to (697·9 to 3087·7) (18·9 to 22·5)* (8·6 to 10·3)* (−9·3 to −7·0)* (−4·8 to −3·3)*
2 525 509·0) 2 665 441·2)
Periodontal disease 796 122·9 71 483·7 5185·6 50·2% 26·6% 3·2% 2·8%
(670 981·0 to 930 283·0) (61 593·0 to 81 227·2) (2039·3 to 10 653·7) (48·8 to 51·6)* (25·1 to 27·9)* (2·6 to 3·7)* (2·3 to 3·2)*
Edentulism and severe 267 457·5 18 452·1 7345·9 40·8% 24·6% −6·3% −4·1%
tooth loss (235 214·4 to 300 011·3) (16 192·9 to 20 997·1) (4894·2 to (39·4 to 42·1)* (23·7 to 25·5)* (−7·1 to −5·5)* (−4·7 to −3·4)*
10 408·2)
Other oral disorders 139 086·3 ·· 4015·1 32·7% 15·7% 0·0% 0·2%
(133 117·0 to 145 643·0) (2507·7 to 5900·3) (31·9 to 33·6)* (15·0 to 16·3)* (−0·3 to 0·4) (−0·1 to 0·5)
Injuries 1 507 481·4 520 710·3 57 174·5 23·7% 23·4% −10·4% 2·9%
(1 439 758·0 to (493 430·2 to (42 073·9 to (22·1 to 25·3)* (22·0 to 24·8)* (−11·2 to −9·5)* (2·1 to 3·7)*
1 587 209·4) 547 988·6) 75 427·0)
Transport injuries 226 305·6 63 920·6 13 394·4 32·9% 21·6% −4·0% 1·2%
(209 529·5 to 244 291·1) (56 848·5 to 71 592·2) (9586·9 to (30·5 to 35·3)* (20·4 to 22·9)* (−5·4 to −2·7)* (0·4 to 2·0)*
17 861·0)
Road injuries 174 209·6 54 192·3 10 159·7 42·8% 21·7% 1·7% 0·5%
(162 042·0 to 187 472·1) (47 381·6 to 61 645·9) (7272·0 to 13 618·8) (41·0 to 44·8)* (20·5 to 22·9)* (0·6 to 2·8)* (−0·3 to 1·3)
Pedestrian road injuries 46 000·9 11 038·9 2710·1 35·6% 18·1% −3·1% −2·4%
(39 776·2 to 54 538·8) (9097·7 to 13 168·8) (1912·5 to 3722·5) (32·3 to 38·5)* (16·2 to 19·8)* (−4·8 to −1·5)* (−3·6 to −1·3)*
Cyclist road injuries 30 602·6 11 912·9 1701·1 49·1% 27·8% 6·6% 5·1%
(25 887·6 to 35 843·6) (9669·7 to 14 669·8) (1203·1 to 2311·2) (45·4 to 52·5)* (25·6 to 29·8)* (4·5 to 8·4)* (3·9 to 6·4)*
Motorcyclist road injuries 43 911·6 10 099·8 2563·7 61·6% 22·5% 15·6% 2·0%
(37 802·2 to 50 950·2) (8264·3 to 12 257·1) (1759·1 to 3510·3) (58·6 to 64·8)* (20·7 to 24·4)* (14·0 to 17·3)* (0·6 to 3·4)*
Motor vehicle road injuries 42 004·6 16 209·2 2568·1 30·8% 16·3% −7·7% −4·5%
(36 541·9 to 49 398·3) (13 485·6 to 19 383·3) (1842·3 to 3439·8) (29·3 to 32·4)* (14·8 to 17·7)* (−8·5 to −6·9)* (−5·6 to −3·5)*
Other road injuries 11 689·9 4931·4 616·6 52·6% 45·4% 9·0% 20·3%
(9728·7 to 14 348·1) (3777·3 to 6241·2) (438·2 to 853·2) (49·6 to 55·3)* (42·4 to 47·9)* (7·4 to 10·5)* (18·6 to 21·8)*
Other transport injuries 52 096·1 9728·3 3234·7 9·0% 21·4% −18·5% 3·5%
(43 127·5 to 61 355·1) (8120·6 to 11 627·0) (2315·7 to 4345·0) (6·9 to 11·4)* (19·8 to 23·3)* (−19·8 to −17·2)* (2·0 to 5·0)*
Unintentional injuries 935 298·2 415 410·3 36 509·7 19·8% 26·5% −13·8% 4·5%
(876 022·5 to (390 092·6 to (26 384·7 to (18·0 to 21·6)* (25·2 to 27·7)* (−14·7 to −12·8)* (3·7 to 5·3)*
1 008 077·1) 441 943·0) 49 052·5)
Falls 411 712·0 171 691·2 19 252·7 23·1% 27·7% −12·7% 3·9%
(366 391·0 to 465 355·0) (152 472·7 to 194 061·9) (13 725·4 to (21·3 to 24·9)* (26·5 to 29·0)* (−13·6 to −11·8)* (3·0 to 4·6)*
26 140·4)
Drowning 2207·3 357·5 131·6 −11·2% 14·2% −33·1% −3·8%
(1940·6 to 2531·3) (311·4 to 411·9) (94·3 to 175·8) (−14·0 to −8·2)* (10·4 to 17·9)* (−34·9 to −31·2)* (−6·6 to −1·3)*
Fire, heat, and hot substances 99 746·8 8991·5 3177·0 0·8% 17·8% −25·3% 1·1%
(85 298·5 to 115 988·1) (7481·2 to 10 740·9) (2210·4 to 4396·7) (−4·4 to 6·2) (13·9 to 21·7)* (−28·5 to −22·0)* (−1·6 to 3·7)
Poisonings 4556·0 4079·6 467·4 8·6% 29·9% −18·1% 12·2%
(3808·4 to 5352·3) (3287·6 to 4973·7) (308·0 to 663·8) (7·2 to 10·0)* (28·3 to 31·8)* (−19·0 to −17·1)* (10·8 to 13·9)*
Poisoning by carbon 854·2 1043·5 75·5 16·0% 33·4% −13·1% 14·7%
monoxide (717·2 to 1034·9) (770·9 to 1392·2) (50·4 to 109·9) (14·1 to 18·0)* (30·2 to 36·5)* (−14·4 to −11·9)* (12·0 to 17·5)*
Poisoning by other means 3701·8 3036·0 391·9 7·3% 29·3% −19·0% 11·8%
(2951·6 to 4490·9) (2379·5 to 3782·1) (252·7 to 576·0) (5·8 to 8·8)* (27·2 to 31·4)* (−19·9 to −18·0)* (9·9 to 13·7)*
Exposure to mechanical forces 194 479·9 72 503·4 4959·6 16·5% 29·0% −16·0% 7·4%
(169 045·7 to 225 589·9) (62 042·8 to 84 320·6) (3445·4 to 6978·5) (14·3 to 18·6)* (27·6 to 30·5)* (−17·2 to −14·9)* (6·5 to 8·4)*
Unintentional firearm 8469·2 1911·8 320·1 13·7% 28·0% −16·5% 8·6%
injuries (6941·4 to 9838·8) (1390·6 to 2544·6) (224·6 to 436·7) (12·2 to 15·2)* (26·5 to 29·5)* (−17·4 to −15·7)* (7·7 to 9·6)*
Other exposure to 186 010·7 70 591·6 4639·5 16·7% 29·1% −16·0% 7·3%
mechanical forces (159 749·5 to 216 401·4) (60 734·7 to 82 371·3) (3204·1 to 6560·6) (14·4 to 18·9)* (27·7 to 30·6)* (−17·2 to −14·8)* (6·3 to 8·4)*
Adverse effects of medical 2673·1 34 975·0 356·5 60·5% 48·0% 18·5% 19·6%
treatment (2059·9 to 3308·5) (29 997·9 to 40 308·2) (223·9 to 533·8) (55·4 to 65·6)* (41·2 to 54·5)* (16·0 to 21·0)* (15·3 to 24·0)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Animal contact 38 403·6 43 844·6 1075·6 11·3% 17·9% −17·0% 1·1%
(34 169·0 to 43 179·8) (37 631·9 to 51 149·2) (732·1 to 1484·0) (9·7 to 12·9)* (16·1 to 19·6)* (−17·9 to −16·2)* (−0·2 to 2·3)
Venomous animal contact 15 812·1 21 097·9 717·2 14·7% 18·2% −13·6% 2·7%
(13 211·3 to 18 557·7) (17 255·4 to 25 592·6) (487·1 to 1004·2) (12·7 to 17·1)* (16·2 to 20·3)* (−14·8 to −12·2)* (1·1 to 4·3)*
Non-venomous animal 22 591·5 22 746·6 358·4 5·0% 17·2% −22·9% −1·8%
contact (19 045·6 to 26 729·8) (18 607·8 to 27 654·5) (224·3 to 555·6) (2·4 to 7·6)* (14·8 to 19·1)* (−24·3 to −21·8)* (−3·5 to −0·5)*
Foreign body 19 350·9 23 101·7 949·3 16·3% 21·5% −13·0% 3·4%
(16 787·2 to 22 108·8) (19 925·9 to 26 454·1) (683·3 to 1285·0) (13·6 to 19·1)* (20·3 to 22·9)* (−15·0 to −11·0)* (2·4 to 4·5)*
Pulmonary aspiration and 3008·1 1346·3 150·4 12·2% 23·8% −14·1% 5·8%
foreign body in airway (2442·0 to 3662·4) (1115·6 to 1607·1) (103·1 to 204·4) (6·2 to 19·3)* (20·7 to 26·9)* (−17·9 to −9·5)* (3·6 to 8·2)*
Foreign body in eyes 3190·4 17 672·8 201·6 20·3% 20·3% −9·4% 2·7%
(1644·6 to 4857·3) (14 633·0 to 20 947·8) (104·6 to 334·5) (17·7 to 23·1)* (18·8 to 22·1)* (−12·1 to −7·4)* (1·3 to 3·6)*
Foreign body in other body 13 152·5 4082·5 597·3 16·0% 21·4% −13·9% 3·1%
part (10 991·9 to 15 298·2) (3342·2 to 5009·6) (427·3 to 783·4) (13·3 to 19·2)* (20·0 to 22·9)* (−15·6 to −11·9)* (1·8 to 4·3)*
Environmental heat and cold 34 896·7 8769·0 1509·5 13·6% 24·5% −16·7% 4·9%
exposure (29 946·9 to 40 886·4) (7357·0 to 10 370·5) (1072·5 to 2023·8) (11·0 to 16·4)* (22·3 to 26·6)* (−18·2 to −15·1)* (3·4 to 6·4)*
Exposure to forces of nature 15 757·0 689·2 725·5 220·3% 22·6% 156·4% 7·8%
(11 656·5 to 20 853·3) (587·4 to 817·5) (524·9 to 975·9) (200·7 to 238·8)* (19·0 to 26·1)* (140·2 to 171·7)* (5·0 to 10·4)*
Other unintentional injuries 115 519·2 46 407·6 3904·9 20·4% 28·4% −13·9% 5·7%
(98 844·3 to 134 764·7) (39 513·5 to 53 786·8) (2715·6 to 5485·4) (18·4 to 22·2)* (27·0 to 29·7)* (−14·9 to −13·0)* (4·9 to 6·6)*
Self-harm and interpersonal 351 859·6 41 379·4 7270·4 27·2% 13·0% −3·5% −2·0%
violence (316 749·7 to 390 321·7) (37 344·5 to 45 834·4) (5637·2 to 9008·3) (24·7 to 30·0)* (10·8 to 15·0)* (−5·4 to −1·3)* (−3·7 to −0·5)*
Self-harm 8502·0 3939·8 435·3 18·5% 6·3% −16·0% −12·1%
(7072·4 to 10 011·6) (3338·1 to 4603·3) (306·0 to 574·8) (15·2 to 21·9)* (4·8 to 7·9)* (−18·2 to −13·9)* (−13·1 to −11·1)*
Self-harm by firearm 114·4 41·6 4·8 13·5% 7·6% −21·3% −12·9%
(100·5 to 130·9) (26·1 to 63·2) (3·4 to 6·5) (11·6 to 15·7)* (5·3 to 9·9)* (−22·7 to −19·9)* (−14·7 to −11·1)*
Self-harm by other specified 8387·6 3898·2 430·5 18·6% 6·3% −16·0% −12·1%
means (6963·0 to 9894·9) (3299·6 to 4570·6) (301·7 to 568·8) (15·2 to 22·0)* (4·8 to 7·9)* (−18·1 to −13·9)* (−13·1 to −11·1)*
Interpersonal violence 297 781·5 22 919·4 4561·8 24·0% 14·6% −7·4% −0·8%
(268 378·9 to 330 722·3) (19 569·3 to 26 696·3) (3522·0 to 5756·8) (21·7 to 26·3)* (13·1 to 15·9)* (−8·7 to −5·9)* (−1·6 to −0·0)*
Assault by firearm 2599·6 551·9 116·9 41·0% 20·2% 1·1% 0·5%
(2158·5 to 3151·0) (421·7 to 725·6) (83·8 to 159·3) (38·7 to 43·5)* (18·3 to 22·0)* (−0·3 to 2·4) (−0·9 to 1·9)
Assault by sharp object 14 754·5 4233·0 475·1 21·0% 13·8% −12·0% −3·4%
(12 033·6 to 20 359·8) (3265·4 to 5366·7) (333·8 to 659·8) (18·2 to 23·7)* (12·1 to 15·7)* (−13·5 to −10·5)* (−4·9 to −1·9)*
Sexual violence 238 200·3 ·· 2142·0 26·1% 12·4% −1·9% 0·6%
(209 368·6 to 270 335·5) (1447·1 to 3106·7) (22·5 to 30·1)* (10·2 to 14·3)* (−3·5 to −0·1)* (−0·6 to 1·6)
Assault by other means 42 227·1 18 134·5 1827·8 21·3% 17·1% −12·4% −1·9%
(35 479·3 to 50 750·5) (15 426·3 to 21 180·0) (1295·0 to 2446·7) (18·4 to 24·5)* (15·7 to 18·6)* (−14·1 to −10·6)* (−3·0 to −0·7)*
Conflict and terrorism 41 912·3 12 492·6 2134·0 35·1% 10·1% 8·2% −3·2%
(28 964·3 to 59 365·8) (10 797·4 to 15 087·4) (1438·2 to 3191·0) (30·0 to 40·8)* (4·9 to 15·5)* (4·0 to 12·7)* (−7·6 to 1·4)
Executions and police conflict 3680·5 2027·6 139·3 59·4% 32·9% 22·3% 14·6%
(2459·9 to 5304·1) (1683·1 to 2486·1) (99·1 to 197·0) (45·9 to 74·0)* (27·9 to 51·1)* (11·9 to 33·5)* (9·9 to 31·1)*
Nature of injury aggregates
Amputations 371 422·5 9847·8 6409·0 17·4% 19·6% −15·5% −0·4%
(343 523·2 to 407 748·4) (8414·6 to 11 519·6) (4283·7 to 9318·6) (12·9 to 21·9)* (15·7 to 23·2)* (−18·6 to −12·2)* (−3·5 to 2·4)
Burns 208 679·9 14 307·6 6720·1 5·8% 14·3% −21·0% −1·5%
(192 327·8 to 227 204·0) (12 437·8 to 16 359·2) (4841·1 to 9083·9) (0·9 to 11·2)* (10·1 to 18·6)* (−24·2 to −17·8)* (−4·3 to 1·2)
Fractures 360 136·5 139 646·3 19 793·8 30·3% 27·3% −8·6% 3·0%
(338 070·9 to 385 693·0) (128 305·0 to 152 504·8) (13 702·1 to (29·1 to 31·5)* (26·1 to 28·3)* (−9·3 to −7·8)* (2·1 to 3·7)*
27 655·9)
Head injuries 46 873·2 21 652·5 6898·0 35·6% 27·9% −2·5% 6·2%
(44 984·0 to 48 892·5) (19 206·0 to 24 416·0) (4883·9 to 9277·6) (34·5 to 36·8)* (27·1 to 28·7)* (−3·2 to −1·8)* (5·6 to 6·9)*
Spinal injuries 22 489·5 775·8 6633·4 26·1% 25·0% −6·6% 6·3%
(20 671·6 to 25 115·6) (643·3 to 957·7) (4708·0 to 8639·5) (23·4 to 28·9)* (22·9 to 26·6)* (−8·7 to −4·1)* (5·0 to 7·3)*


1990–2007 2007–17 rates, 1990–2007 rates, 2007–17
Minor injuries 198 921·3 181 177·5 1752·5 25·5% 27·5% −10·2% 5·1%
(187 143·0 to 213 281·5) (167 026·3 to 195 833·2) (831·1 to 3319·5) (24·1 to 27·1)* (26·8 to 28·4)* (−11·1 to −9·2)* (4·6 to 5·8)*
Other injuries 71 339·1 153 302·9 6825·7 20·4% 23·1% −10·7% 4·1%
(67 479·1 to 75 358·0) (143 603·2 to 162 955·6) (4830·6 to 9168·5) (18·7 to 22·4)* (21·0 to 24·8)* (−11·8 to −9·4)* (2·6 to 5·4)*
Impairments
Anaemia 1 950 345·6 ·· 58 197·1 −0·9% −6·7% −17·1% −16·2%
(1 909 153·0 to (39 535·4 to (−3·3 to 1·5) (−9·5 to −3·8)* (−18·9 to −15·2)* (−18·8 to −13·5)*
1 990 086·8) 83 046·0)
Epilepsy 63 783·6 ·· 25 957·3 34·1% 16·3% 8·8% 4·5%
(55 496·5 to 73 199·5) (20 369·4 to (25·9 to 42·1)* (10·6 to 22·1)* (1·9 to 15·2)* (−0·7 to 9·8)
32 900·4)
(82·7 to 127·2) (19·3 to 44·4) (25·5 to 33·8)* (15·9 to 21·0)* (1·0 to 4·3)* (2·2 to 4·5)*
Hearing loss 1 428 450·1 ·· 39 454·3 40·0% 22·4% 0·0% −0·5%
(1 388 276·9 to (27 100·6 to (38·7 to 41·0)* (21·4 to 23·3)* (−0·7 to 0·6) (−1·2 to 0·1)
1 465 389·9) 55 310·2)
Heart failure 64 343·9 ·· 9906·9 55·4% 32·6% −0·4% −0·5%
(57 187·0 to 71 648·3) (7261·9 to 12 443·6) (51·7 to 59·1)* (30·3 to 34·6)* (−2·6 to 1·9) (−2·0 to 0·7)
Infertility 123 084·9 ·· 956·9 31·7% 17·3% −0·7% 6·8%
(99 543·3 to 150 556·1) (487·4 to 1791·9) (28·0 to 34·8)* (13·6 to 20·5)* (−3·0 to 1·0) (3·5 to 9·8)*
Developmental intellectual 188 585·1 ·· 25 301·2 30·2% 12·9% 7·1% 2·1%
disability (145 641·8 to 230 402·8) (19 706·5 to (25·9 to 35·0)* (10·0 to 16·1)* (3·7 to 11·0)* (−0·5 to 5·1)
31 400·2)
Pelvic inflammatory disease 1064·1 ·· 141·0 42·3% 16·0% 4·5% 2·5%
(906·7 to 1249·0) (94·8 to 197·2) (39·0 to 45·9)* (13·6 to 18·7)* (2·5 to 6·7)* (0·4 to 4·7)*
Vision loss 1 339 970·3 ·· 34 125·4 38·3% 22·2% −2·4% −1·5%
(1 291 077·0 to (23 206·6 to (36·9 to 39·6)* (21·2 to 23·3)* (−3·2 to −1·6)* (−2·3 to −0·7)*
1 393 811·0) 48 924·6)
Data in parentheses are 95% uncertainty intervals. We did not calculate incidence for the nine impairments and certain neglected tropical diseases. Blank cells mean that no estimate is available or that the estimate
has a magnitude less than 50. G6PD=glucose-6-phosphate dehydrogenase. GFR=glomerular filtration rate. H influenzae=Haemophilus influenzae. NASH=non-alcoholic steatohepatitis. YLDs=years lived with
disability. *Percentage changes that are statistically significant. †Incidence of HIV/AIDS represents new infections of HIV only and does not include new infections of tuberculosis in HIV positive cases. ‡Incidence
estimates for stroke represent first-ever stroke only.
Table 1: Global prevalence, incidence, and YLDs for 2017; percentage change of YLD counts; and percentage change of age-standardised YLD rates for 1990–2007 and 2007–17 for both
sexes combined for all Level 5 causes, nature of injury aggregates, and nine impairments
The most common Level 3 causes of YLD rates by whereas in the highest SDI quintile it was low back pain
country and subnational locations by sex are shown in for both females and males. In the lowest SDI quintile,
appendix 2. In both females and males, low back pain for both sexes combined, the top three causes of YLD
was the leading Level 3 cause by country. In females, rates were low back pain, dietary iron deficiency, and
the second most commonly leading Level 3 cause headache disorders, while in the highest SDI quintile
was headache disorders, which was the leading cause in the top three causes were low back pain, headache
57 countries, followed by diabetes, which was the leading disorders, and depressive disorders (appendix 2). The
cause in 20 countries. In males, the second most supplementary results show these results for the leading
commonly leading Level 3 cause was diabetes, highest in six impairments estimated in GBD: anaemia, heart
39 countries, followed by drug use disorders and conflict failure, vision loss, hearing loss, epilepsy, and infertility
and terror, each leading in five countries. (appendix 2). The immense burden of anaemia is shown,
particularly for females in low-SDI regions. The
Temporal YLD trends in causes and impairments by differences in the burden of impairments by sex are also
geographical regions and SDI quintiles provided (appendix 2).
Figure 3 shows rankings and trends of the top causes of Figure 4 shows the all-age and age-standardised YLD
YLDs by SDI quintile and by sex. SDI-based patterns rates by SDI and GBD region between 1990 and 2017 for
varied by sex: the top cause of YLD rates between 1990 males and females combined for all causes and then
and 2017 in the lowest SDI quintile was dietary iron separately for Level 1 causes. In general, many regions
deficiency for females and low back pain for males, experienced decreases in all-cause age-standardised

HIV/AIDS
Onchocerciasis
Neonatal disorders
Dietary iron deficiency
Stroke
COPD
Drug use disorders
Depressive disorders
Diabetes
Low back pain
Neck pain
Age-related hearing loss
Nature disaster
Conflict and terrorism
Headache disorders
Blindness and vision impairment
ATG VCT Barbados Comoros Marshall Isl Kiribati

West Africa Eastern
Mediterranean
Solomon Isl FSM
Dominica Grenada Maldives Mauritius Malta

Vanuatu Samoa
Caribbean LCA TTO TLS Seychelles Persian Gulf Singapore Balkan Peninsula Fiji Tonga
Figure 2: Leading Level 3 causes of age-standardised YLD rates by location for both sexes combined, 2017
ATG=Antigua and Barbuda. COPD=chronic obstructive pulmonary disease. FSM=Federated States of Micronesia. Isl=Islands. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago.
VCT=Saint Vincent and the Grenadines. YLD=years lived with disability.
YLD rates as SDI increased (figure 4). However, there the relative difference between the sexes in 1990 and 2017.
were important exceptions to this finding. First, some In both 1990 and 2017, the cause with the greatest relative
regions did not follow this trend consistently. Southern difference between sexes was substance use disorders,
sub-Saharan Africa showed an increase in YLD rates for which had a relative difference of 1·09 (95% UI 1·03–1·15)
more than a decade before beginning a more precipitous in 1990, which increased to 1·16 (1·09–1·23) in 2017. In
decline coinciding with the apex of the HIV epidemic, 1990, 302 million (226–388) YLDs were in females and
whereas regions with a higher baseline SDI have generally 260 million (195–336) were in males. The all-age YLD rate
experienced minimal changes or increases in age- for females was 11 273·6 (8455·6–14 492·5) per 100 000 and
standardised YLD rates over the past decade despite the all-age YLD for males was 9571·4 (7160·9–12 356·1) per
advances in SDI. We found that trends also varied over 100 000 in 1990. Among the global sum of YLDs, 53·6%
time depending on cause. As SDI increased, age- (53·3–53·9) or 457 million (344–587) YLDs were in
standardised and all-age YLDs improved for CMNN females and 46·4% (46·1–46·7) or 396 million (297–510)
causes in most regions, but this relation was less reliable YLDs were in males. In the subset of causes that occur in
for NCDs. The NCD pattern also differed markedly both males and females, there were 761 million (565–987)
between all-age and age-standardised rates for NCDs, with total YLDs, with 53·0% (52·8–53·2) or 444 million
all-age rates increasing as SDI improved with relatively (334–571) YLDs in females and 47·0% (46·8–47·2) or
little change over time observed in age-standardised rates. 395 million (296–510) YLDs in males. Between 1990 and
For injuries, some regions initially experienced a declining 2017, all-age YLD rates increased for females and males,
burden as SDI increased, followed by an increasing
burden as SDI continued to increase over time, as seen in
Central Europe, for example. Figure 3: Trends of age-standardised YLD rates per 100 000 for the top eight
Level 3 causes of non-fatal burden in 2017 for each sex by SDI quintile,
Age-specific and sex-specific patterns in prevalence 1990–2017
Mean estimates are shown. SDI=Socio-demographic Index. YLDs=years lived
and YLDs with disability. *One legend is shown for females and males. Anxiety disorders
Table 2 shows global age-standardised prevalence for are a top cause of non-fatal burden for females and other musculoskeletal
females and males for all Level 2 GBD causes as well as disorders are a top cause of non-fatal burden for males.

Age-related and other hearing loss Anxiety disorders* Chronic obstructive pulmonary disease
Depressive disorders Diabetes Dietary iron deficiency
Headache disorders Low back pain Other musculoskeletal disorders*
Females
Low SDI Low-middle SDI Middle SDI High-middle SDI High SDI
1400
1120
Age-standardised YLD rates per 100 000 people
840
560
280
Males
Low SDI Low-middle SDI Middle SDI High-middle SDI High SDI
1400
1120
Age-standardised YLD rates per 100 000 people
840
560
280
0
1990 1995 2000 2005 2010 2017 1990 1995 2000 2005 2010 2017 1990 1995 2000 2005 2010 2017 1990 1995 2000 2005 2010 2017 1990 1995 2000 2005 2010 2017
Year Year Year Year Year

All ages Age standardised

All causes
140 140
YLD rate per 1000 people
120 120
100 100
80 80
Communicable, maternal, neonatal, and nutritional diseases
40 40
30 30
20 20
10 10
0 0
Non-communicable diseases
130 105
100
110
95
90 90
85
70
80
50 75
Injuries
20 20
15 15
10 10
5 5
0 0
0·2 0·4 0·6 0·8 0·2 0·4 0·6 0·8
SDI SDI
Global Central Europe Southern Latin America Tropical Latin America Southern sub-Saharan Africa
East Asia Eastern Europe High-income North America North Africa and Middle East Western sub-Saharan Africa
Southeast Asia High-income Asia Pacific Caribbean South Asia
Oceania Australasia Andean Latin America Central sub-Saharan Africa
Central Asia Western Europe Central Latin America Eastern sub-Saharan Africa

by 6·5% (5·4–7·7) to 12 007·7 (9036·7–15352·0) YLDs per deficiencies. From age 10–14 years and older, females
100 000 females and by 7·9% (6·6–9·2) to 10 328·1 have greater overall YLD rates in every age group. Under
(7744·1–13 306·9) YLDs per 100 000 males. the age of 1 year, females experience higher YLD rates
Figure 5A illustrates the differences in global prevalence due to neoplasms and maternal and neonatal disorders,
for females and males for 2017 by age group for the whereas male infants experience higher YLD rates due to
22 Level 2 GBD causes of non-fatal health loss, calculated nutritional deficiencies and other NCDs. Starting at age
as the female-specific estimate subtracted from the male- 10 years, females experience a higher YLD rate due to
specific estimate such that causes on the left side of the other NCDs (until age 50–54 years), musculoskeletal
chart are more prevalent in females while causes on the disorders, mental disorders, neurological disorders, and
right side of the chart are more prevalent in males in a chronic respiratory diseases. Males experience higher
given age group. Females experience overall higher YLD rates due to unintentional injuries, transport
prevalence in every age group and the highest age-specific injuries, and substance use disorders for most of life,
global prevalence differences for female-predominant although females older than 80 years of age experience a
causes occur between the ages of 20 years and 49 years. higher rate of unintentional injuries than do males. For
From birth to 4 years of age, females have higher prevalence self-harm and interpersonal violence, females experience
of other NCDs, which continues through all age groups, higher rates than males until age 30–34 years, at which
and of neoplasms than males, whereas neurological point males experience higher YLD rates. Males also
disorders are female predominant in all ages, becoming experience higher YLD rates from neoplasms, cardio
notably evident from age 5–9 years and continuing vascular diseases, and other NCDs starting in older age
throughout all subsequent age groups. Similarly, groups (≥60 years), and from digestive diseases from age
HIV/AIDS and sexually transmitted infections are female 25–29 years.
predominant in all ages, a trend that becomes evident Figure 6 shows the extent to which males and females
from age 10–14 years. Although nutritional deficiencies are in region–cause combinations have diverged in terms of
more prevalent in males in the earliest age groups up to achieving equal change over time between 1990 and 2017.
age 9 years, they are more prevalent in females in sub Each region–cause combination shows which sex has
sequent age groups up to age 74 years, at which point they performed better over time either by decreasing more or
once again become more prevalent in males up to the by increasing less in terms of age-standardised YLD rates.
oldest age group. Females also have higher prevalence of Among the 462 region–cause combinations (excluding
self-harm and interpersonal violence starting from age any “Global” or “All causes” combinations), females had
1–4 years and continuing until age 84 years, after which more favourable outcomes over time for 260 combinations
they become more prevalent in males. Digestive diseases (56·3%), and males had more favourable outcomes for
are more prevalent in males in all age groups, whereas 202 combinations (43·7%). The Z score, that is, the
unintentional injuries emerge as a male-predominant number of SDs from equality, was 0·433 for the mean
cause from 5 years of age and remain as such until age deviation of female-favourable causes and 0·313 for the
89 years, after which they become female predominant. mean deviation of male-favourable causes.
Transport injuries are male predominant in all age groups Figure 7 shows the leading 20 causes of prevalence
starting from age 1–4 years. Respiratory infections and and YLDs for females and males separately for 1990,
tuberculosis are male predominant in all ages. Cardio 2007, and 2017, with percentage change. In 1990, the
vascular diseases are male predominant starting from age most common causes for females were oral dis
50–54 years, whereas chronic respiratory diseases emerge orders, headache disorders, and haemoglobinopathies
as a male-predominant cause from age 65–69 years. and haemolytic anaemias, whereas for males, the most
Figure 5B shows the sex differences in the global common causes were oral disorders, headache disorders,
burden of YLDs for 2017 by age group for the and tuberculosis including latent tuberculosis. The
22 Level 2 GBD causes of non-fatal health loss. Before number of prevalent cases in the top three leading causes
age 10–14 years, males have greater YLD rates than for females increased by 23·1% (95% UI 21·8 to 24·5) for
females, driven largely by higher rates of nutritional oral disorders, 31·5% (30·2 to 32·8) for headache
disorders, and 29·9% (29·6 to 30·1) for haemoglobino
pathies and haemolytic anaemias between 1990 and 2007.
Between 2007 and 2017, the number of cases increased
Figure 4: Co-evolution of all-age and age-standardised YLD rates with SDI further by 13·5% (12·9 to 14·1), 14·5% (13·8 to 15·3), and
globally and for GBD regions for Level 1 causes for both sexes combined,
1990–2017 13·4% (13·2 to 13·6), respectively (figure 7A). Between
Coloured lines are global and region values for YLDs. Each point in a line 1990 and 2007, for males, the number of prevalent cases
represents 1 year, starting from 1990 and ending in 2017. In all regions, SDI has of oral disorders increased by 21·6% (20·1 to 23·1),
increased over time so progress in SDI is associated with points further to the
the number of headache disorders increased by 31·3%
right and later years for a given region, with a downwards gradient indicating a
reduction in YLD rate. The black lines indicate the trajectories for each geography (29·9 to 32·8), and the number of prevalent cases
expected on the basis of SDI alone. SDI=Socio-demographic Index. of tuberculosis including latent tuberculosis infection
YLDs=years lived with disability. increased by 26·2% (21·7 to 30·3). Between 2007 and

Prevalence in thousands, 1990 Prevalence in thousands, 2017 Percentage change, 1990–2017

Males Females Sex difference Males Females Sex difference Males Females
Substance use disorders 3008 1439 1·09 3018 1400 1·16 0·3% −2·7%
(2773 to 3237) (1319 to 1557) (1·03 to 1·15) (2782 to 3252) (1279 to 1524) (1·09 to 1·23) (−1·2 to 2·0) (−4·1 to −1·2)
Unintentional injuries 14 678 10 230 0·43 13 773 9747 0·41 −6·2% −4·7%
(13 770 to 15 758) (9589 to 10 981) (0·40 to 0·47) (12 888 to 14 884) (9148 to 10 484) (0·38 to 0·45) (−6·8 to −5·4) (−5·6 to −3·8)
Self-harm and 3193 5637 0·43 3265 5643 0·42 2·3% 0·1%
interpersonal violence (2893 to 3529) (5058 to 6278) (0·39 to 0·48) (2943 to 3630) (5057 to 6302) (0·37 to 0·47) (−0·1 to 4·9) (−1·5 to 1·7)
HIV/AIDS and sexually 11 433 18 320 0·38 11 902 18 936 0·37 4·1% 3·4%
transmitted infections (10 355 to 12 703) (16 789 to 19 998) (0·36 to 0·39) (10 826 to 13 196) (17 366 to 20 631) (0·36 to 0·39) (3·3 to 4·9) (2·6 to 4·1)
Transport injuries 3150 2367 0·33 3322 2336 0·42 5·4% −1·3%
(2924 to 3384) (2189 to 2576) (0·30 to 0·37) (3082 to 3582) (2154 to 2535) (0·39 to 0·47) (4·1 to 7·2) (−2·6 to 0·0)
Neoplasms 917 1191 0·23 1188 1355 0·12 29·6% 13·8%
(871 to 938) (1167 to 1219) (0·21 to 0·27) (1146 to 1244) (1318 to 1391) (0·07 to 0·16) (26·4 to 34·9) (9·4 to 17·7)
Other non-communicable 57 424 73 370 0·22 55 565 72 470 0·23 −3·2% −1·2%
diseases (55 351 to 59 629) (72 026 to 74 850) (0·20 to 0·23) (53 542 to 57 701) (71 183 to 73 891) (0·22 to 0·25) (−3·7 to −2·8) (−1·5 to −1·0)
Maternal and neonatal 1435 1820 0·21 1953 2288 0·15 36·1% 25·7%
disorders (1264 to 1629) (1643 to 2018) (0·18 to 0·25) (1712 to 2208) (2027 to 2586) (0·11 to 0·18) (29·3 to 43·0) (18·9 to 32·2)
Digestive diseases 26 590 22 435 0·19 28 165 23 417 0·20 5·9% 4·4%
(25 678 to 27 503) (21 585 to 23 377) (0·17 to 0·20) (27 283 to 29 064) (22 581 to 24 342) (0·19 to 0·21) (5·1 to 6·8) (3·7 to 5·1)
Neurological disorders 36 664 42 703 0·14 36 952 42 718 0·14 0·8% 0·0%
(34 401 to 39 294) (40 642 to 45 164) (0·13 to 0·16) (34 695 to 39 469) (40 688 to 45 034) (0·12 to 0·15) (−0·1 to 1·6) (−0·6 to 0·7)
Musculoskeletal disorders 15 247 17 770 0·14 14 918 17 581 0·15 −2·2% −1·1%
(14 414 to 16 131) (16 882 to 18 766) (0·13 to 0·15) (14 143 to 15 761) (16 745 to 18 503) (0·14 to 0·16) (−3·0 to −1·4) (−2·0 to −0·2)
Nutritional deficiencies 28 066 31 354 0·11 23 473 26 059 0·10 −16·4% −16·9%
Diabetes and kidney 10 920 12 120 0·10 12 036 13 044 0·08 10·2% 7·6%
diseases (10 428 to 11 489) (11 558 to 12 743) (0·09 to 0·11) (11 453 to 12 688) (12 444 to 13 733) (0·07 to 0·09) (8·1 to 12·5) (5·6 to 9·6)
Enteric infections 1115 1216 0·08 1180 1313 0·10 5·8% 8·0%
(1043 to 1189) (1141 to 1292) (0·07 to 0·09) (1096 to 1261) (1221 to 1405) (0·09 to 0·11) (2·8 to 9·1) (5·0 to 11·3)
Respiratory infections and 33 220 31 051 0·07 29 021 27 301 0·06 −12·6% −12·1%
tuberculosis (29 889 to 37 160) (27 950 to 34 713) (0·06 to 0·08) (26 238 to 32 454) (24 756 to 30 428) (0·06 to 0·07) (−14·2 to −11·0) (−13·5 to −10·7)
Mental disorders 12 264 13 237 0·07 12 010 12 834 0·06 −2·1% −3·0%
Cardiovascular diseases 6496 6149 0·06 6253 5939 0·05 −3·8% −3·4%
(6261 to 6744) (5904 to 6414) (0·05 to 0·07) (6031 to 6482) (5716 to 6177) (0·04 to 0·06) (−4·4 to −3·1) (−4·1 to −2·7)
Chronic respiratory diseases 7926 8411 0·06 6731 7267 0·07 −15·1% −13·6%
Skin and subcutaneous 25 139 26 565 0·05 25 221 26 592 0·05 0·3% 0·1%
diseases (24 328 to 26 021) (25 776 to 27 407) (0·05 to 0·06) (24 454 to 26 042) (25 832 to 27 377) (0·05 to 0·06) (−0·4 to 1·0) (−0·5 to 0·6)
Other infectious diseases 1574 1633 0·04 1336 1381 0·03 −15·1% −15·4%
Neglected tropical diseases 29 748 28 954 0·03 17 001 16 834 0·01 −42·8% −41·9%
and malaria (28 431 to 31 138) (27 613 to 30 320) (0·02 to 0·03) (16 259 to 17 864) (16 104 to 17 681) (0·00 to 0·02) (−46·3 to −38·7) (−45·5 to −37·6)
Sense organ diseases 25 031 25 473 0·02 24 868 25 892 0·04 −0·7% 1·6%
(24 477 to 25 581) (24 949 to 26 007) (0·01 to 0·02) (24 325 to 25 411) (25 375 to 26 438) (0·03 to 0·04) (−0·8 to −0·5) (1·4 to 1·9)
Data in parentheses are 95% uncertainty intervals. The relative difference for each of the 22 Level 2 causes between sexes were calculated using the values for females as the denominator. The causes are ranked
by the value of the sex difference in 1990. All changes are significant.
Table 2: Global age-standardised prevalence rates per 100 000 for males and females for Level 2 GBD causes with the relative difference between the sexes for 1990 and 2017
2017, the number of prevalent cases for these three causes and increased by 4·2% (4·0 to 4·4) for haemo
increased by 12·5% (11·9 to 13·1), 14·3% (13·6 to 15·2), globinopathies and haemolytic anaemias between 1990
and 1·1% (−0·67 to 3·01), respectively (figure 7B). The and 2007 and increased by 0·3% (0·1 to 0·6) and 0·8%
age-standardised prevalence of the top cause for females, (0·6 to 1·0), respectively, between 2007 and 2017. In 2017,
oral disorders, decreased by 3·8% (3·3 to 4·3) between oral disorders, headache disorders, and haemo globin
1990 and 2007, and decreased by 1·3% (1·0 to 1·7) opathies and haemolytic anaemias remained the top
between 2007 and 2017. For the second and third top three leading Level 3 causes of global age-standardised
causes for females, the age-standardised prevalence prevalence for females. Between 1990 and 2007, the age-
decreased by 0·4% (−1·0 to 0·3) for headache disorders standardised prevalence for the top three leading causes

A
Females Males
≥95
90–94
85–89
80–84
75–79
70–74
65–69 Causes
60–64 HIV/AIDS and sexually transmitted infections
55–59 Respiratory infections and tuberculosis
Enteric infections
Age (years)
50–54 Neglected tropical diseases and malaria

45–49 Other infectious diseases
Maternal and neonatal disorders
40–44
Nutritional deficiencies
35–39 Neoplasms
30–34 Cardiovascular diseases
Chronic respiratory diseases
25–29 Digestive diseases
20–24 Neurological disorders
Mental disorders
15–19
Substance use disorders
10–14 Diabetes and kidney diseases
5–9 Skin and subcutaneous diseases
Sense organ diseases
1–4 Musculoskeletal disorders
28–364 Other non-communicable diseases
Age (days)
7–27 Transport injuries

Unintentional injuries
0–6 Self-harm and interpersonal violence
80 000 70 000 60 000 50 000 40 000 30 000 20 000 10 000 0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000
Difference in prevalent cases per 100 000 population
B
Females Males
≥95
90–94
85–89
80–84
75–79
70–74
65–69 Causes
60–64 HIV/AIDS and sexually transmitted infections
55–59 Respiratory infections and tuberculosis
Enteric infections
Age (years)
50–54 Neglected tropical diseases and malaria

45–49 Other infectious diseases
40–44
35–39 Neoplasms
30–34 Cardiovascular diseases
25–29 Digestive diseases
20–24 Neurological disorders
Mental disorders
15–19
10–14 Diabetes and kidney diseases
5–9 Skin and subcutaneous diseases
1–4 Musculoskeletal disorders
28–364 Other non-communicable diseases
Age (days)
7–27 Transport injuries

0–6 Self-harm and interpersonal violence
3500 3000 2500 2000 1500 1000 500 0 500 1000 1500 2000 2500 3000 3500
Difference in YLDs per 100 000 population
Figure 5: Sex differences in global prevalence and YLD rates per 100 000 for 22 Level 2 causes by age, 2017
The figure represents the difference in prevalence (A) and YLD rates (B) between males and females as well as the cause composition of those differences for each GBD age group for the Level 2 causes
of non-fatal burden. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. YLDs=years lived with disability.

Respiratory infections and tuberculosis
Self-harm and interpersonal violence

Skin and subcutaneous diseases

Diabetes and kidney diseases
Musculoskeletal disorders
Other infectious diseases

Cardiovascular diseases
Neurological disorders
HIV/AIDS and STIs
Digestive diseases
NTDs and malaria
Transport injuries
Enteric infections
Mental disorders
Other NCDs
Neoplasms
All causes
Central Asia
Central Europe
Eastern Europe
Australasia
High-income Asia Pacific
High-income North America
Southern Latin America
Western Europe
Andean Latin America
Caribbean
Central Latin America
Tropical Latin America
North Africa and Middle East
South Asia
East Asia
Oceania
Southeast Asia
Central sub-Saharan Africa
Eastern sub-Saharan Africa
Southern sub-Saharan Africa
Western sub-Saharan Africa
Global
Direction of overall trend Sex with more favourable trend Deviation from equal relative change over time*
Improving Females (0·000, 0·004]
Divergent Males (0·004, 0·012]
Worsening (0·012, 0·024]
(0·024, 0·058]
(0·058, 1·870]
Figure 6: Absolute difference in non-fatal trend equality for males and females in terms of age-standardised YLD rates, 1990–2017
This figure shows whether females or males experienced more favourable trends between 1990 and 2017 in terms of age-standardised YLDs by GBD region and
Level 2 cause. Circles indicate females experienced more favourable trends and triangles indicate males experienced more favourable trends, where more favourable
refers to either decreasing more or increasing less. Green indicates that the overall trend is improving (ie, decreasing age-standardised YLDs) and red indicates that the
overall trend is worsening (ie, increasing age-standardised YLDs). Yellow indicates cause-regions where one sex is increasing and the other sex is decreasing. For
example, in Andean Latin America for substance use, the large yellow triangle means that males have experienced decreasing age-standardised YLDs whereas the
trend for females is the opposite (ie, increasing age-standardised YLDs). Different sizes refer to greater deviations from equal trends between 1990 and 2017. For
example, for chronic respiratory conditions, males have experienced more favourable trends in both Andean Latin America and the Caribbean, with both regions
having decreasing trends over time for both sexes, but the Caribbean is closer to having equal trends for males and females between 1990 and 2017. GBD=Global
Burden of Diseases, Injuries, and Risk Factors Study. STIs=sexually transmitted infections. NCDs=non-communicable diseases. NTDs=neglected tropical diseases.
YLDs=years lived with disability. *Round brackets indicate excluded endpoints whereas square brackets indicate included endpoints.
for males decreased by 4·3% (3·8 to 4·9) for oral In terms of numbers of YLDs, in 1990, the leading
disorders, increased by less than 0·1% (−0·85 to 0·85) causes for both females and males were low back pain,
for headache disorders, and decreased by 3·1% (0·8 to 5·4) headache disorders, and dietary iron deficiency (figure 8).
for tuberculosis including latent tuberculosis infection.
Between 2007 and 2017, the age-standardised prevalence Figure 7: Leading 20 Level 3 causes of global prevalence for 1990, 2007, and
for males for oral disorders and tuberculosis further 2017, with percentage change in number of cases and all-age and
age-standardised rates for each sex
decreased by 1·6% (1·2 to 2·0) and 11·5% (10·1 to 12·8),
Causes are connected by lines between time periods; solid lines are increases and
respectively, whereas the age-standardised prevalence dashed lines are decreases. For the time periods 1990–2007 and 2007–17, three
for headache disorders increased by 0·7% (0·4 to 0·9). measures of change are shown: percentage change in the number of cases,
In 2017, oral disorders, headache disorders, and tubercu percentage change in the all-age prevalence rate, and percentage change in the
age-standardised prevalence rate. Communicable, maternal, neonatal, and
losis including latent tuberculosis remained the three
nutritional diseases are shown in red; non-communicable causes in blue; and
Level 3 causes with greatest global age-standardised injuries in green. Statistically significant changes are shown in bold. COPD=chronic
prevalence for males. obstructive pulmonary disease. STIs=sexually transmitted infections.

Females
Leading causes 1990 Leading causes 2007 Mean Mean Mean Leading causes 2017 Mean Mean Mean
percentage percentage percentage percentage percentage percentage
change in change in change in age- change in change in change in age-
number of all-age standardised number of all-age standardised
prevalent prevalence prevalence prevalent prevalence prevalence
cases, rate, rate, cases, rate, rate,
1990–2007 1990–2007 1990–2007 2007–17 2007–17 2007–17
1 Oral disorders 1 Oral disorders 23·1 –2·0 –3·8 1 Oral disorders 13·5 0·3 –1·3
2 Headache disorders 2 Headache disorders 31·5 4·7 –0·4 2 Headache disorders 14·5 1·2 0·3
3 Haemoglobinopathies 3 Haemoglobinopathies 29·9 3·3 4·2 3 Haemoglobinopathies 13·4 0·2 0·8
4 Tuberculosis 4 Tuberculosis 27·7 1·6 –2·2 4 Tuberculosis 1·2 –10·6 –11·7
5 Intestinal nematode 5 Gynaecological diseases 34·0 6·6 –2·3 5 Gynaecological diseases 13·3 0·1 –0·5
6 Dietary iron deficiency 6 STIs 40·2 11·6 1·7 6 STIs 17·7 4·0 0·7
7 Gynaecological diseases 7 Dietary iron deficiency 7·2 –14·7 –14·5 7 Blindness and vision impairment 24·1 9·7 0·7
8 STIs 8 Blindness and vision impairment 43·4 14·1 0·9 8 Age-related hearing loss 26·1 11·4 0·9
9 Blindness and vision impairment 9 Intestinal nematode –20·7 –36·9 –34·9 9 Dietary iron deficiency 6·4 –6·0 –4·9
10 Cirrhosis 10 Age-related hearing loss 45·4 15·7 1·2 10 Cirrhosis 23·5 9·2 4·6
11 Age-related hearing loss 11 Cirrhosis 40·8 12·0 5·0 11 Intestinal nematode –15·7 –25·5 –23·4
12 Vitamin A deficiency 12 Vitamin A deficiency 11·4 –11·3 –5·2 12 Upper digestive diseases 21·1 7·0 1·5
13 Fungal skin diseases 13 Upper digestive diseases 37·1 9·1 –1·2 13 Chronic kidney disease 28·2 13·3 3·0
14 Upper digestive diseases 14 Fungal skin diseases 23·0 –2·1 –3·0 14 Vitamin A deficiency 5·9 –6·4 –4·0
15 Chronic kidney disease 15 Chronic kidney disease 43·2 14·0 –1·3 15 Fungal skin diseases 12·5 –0·6 –4·0
16 Low back pain 16 Low back pain 29·6 3·2 –7·7 16 Low back pain 17·4 3·8 –2·7
17 Other skin diseases 17 Other skin diseases 44·2 14·8 5·7 17 Other skin diseases 25·4 10·8 3·9
18 Interpersonal violence 18 Diabetes 70·2 35·4 17·6 18 Diabetes 29·8 14·7 3·8
19 Iodine deficiency 19 Interpersonal violence 28·1 1·9 –2·3 19 Interpersonal violence 14·7 1·4 1·1
20 Anxiety disorders 20 Anxiety disorders 33·1 5·9 0·3 20 Other musculoskeletal 21·6 7·5 0·9
26 Diabetes 21 Other musculoskeletal 23 Anxiety disorders
27 Other musculoskeletal 33 Iodine deficiency 35 Iodine deficiency
Males
1 Oral disorders 1 Oral disorders 21·6 –2·9 –4·3 1 Oral disorders 12·5 –0·2 –1·6
2 Headache disorders 2 Headache disorders 31·3 4·8 0·0 2 Headache disorders 14·3 1·5 0·7
3 Tuberculosis 3 Tuberculosis 26·2 0·7 –3·1 3 Tuberculosis 1·1 –10·2 –11·5
4 Intestinal nematode 4 Cirrhosis 42·5 13·8 6·5 4 Cirrhosis 22·8 9·0 4·6
5 Cirrhosis 5 Haemoglobinopathies 29·0 3·0 3·6 5 Age-related hearing loss 24·3 10·3 0·0
6 Dietary iron deficiency 6 Intestinal nematode –21·4 –37·3 –35·7 6 Haemoglobinopathies 12·7 0·1 0·7
7 Haemoglobinopathies 7 Age-related hearing loss 44·6 15·4 0·4 7 Blindness and vision impairment 23·1 9·3 –0·4
8 Age-related hearing loss 8 Dietary iron deficiency 6·0 –15·4 –14·3 8 Dietary iron deficiency 5·8 –6·1 –5·2
9 Vitamin A deficiency 9 Blindness and vision impairment 39·5 11·3 –2·2 9 STIs 19·7 6·3 1·9
10 Blindness and vision impairment 10 Vitamin A deficiency 9·7 –12·4 –7·1 10 Intestinal nematode –16·7 –26·0 –24·2
11 Fungal skin diseases 11 STIs 38·9 10·9 0·7 11 Vitamin A deficiency 5·6 –6·3 –4·0
12 STIs 12 Fungal skin diseases 20·8 –3·5 –3·5 12 Upper digestive diseases 20·3 6·8 1·3
13 Upper digestive diseases 13 Upper digestive diseases 36·5 9·0 –1·3 13 Fungal skin diseases 10·2 –2·2 –4·6
14 Low back pain 14 Chronic kidney disease 45·6 16·2 –0·1 14 Chronic kidney disease 25·4 11·4 1·1
15 Chronic kidney disease 15 Low back pain 30·3 4·0 –6·8 15 Other skin diseases 26·4 12·2 4·7
16 Other skin diseases 16 Other skin diseases 46·5 16·9 7·1 16 Low back pain 18·0 4·7 –1·3
17 Falls 17 Diabetes 77·6 41·8 21·5 17 Diabetes 29·3 14·8 4·0
18 Diabetes 18 Falls 26·4 0·9 –9·8 18 Falls 26·8 12·6 4·1
19 Asthma 19 Other musculoskeletal 41·6 13·0 0·8 19 Other musculoskeletal 16·7 3·6 –2·9
20 Dermatitis 20 COPD 31·5 4·9 –10·6 20 COPD 15·6 2·6 –10·1
21 COPD 21 Dermatitis 22 Dermatitis
Communicable, maternal, neonatal,
22 Other musculoskeletal 22 Asthma 23 Asthma and nutritional diseases
Injuries

Females
Leading causes 1990 Leading causes 2007 Mean Mean Mean Leading causes 2017 Mean Mean Mean
percentage percentage percentage percentage percentage percentage
change in change in change in age- change in change in change in age-
number of all-age standardised number of all-age standardised
YLDs, YLD rate, YLD rate, YLDs, YLD rate, YLD rate,
1990–2007 1990–2007 1990–2007 2007–17 2007–17 2007–17
2 Headache disorders 2 Headache disorders 34·0 6·7 –0·1 2 Headache disorders 15·3 1·9 0·7
3 Dietary iron deficiency 3 Depressive disorders 32·2 5·2 –3·0 3 Depressive disorders 14·1 0·8 –3·1
4 Depressive disorders 4 Dietary iron deficiency 0·3 –20·2 –18·8 4 Dietary iron deficiency –5·0 –16·0 –14·6
5 Anxiety disorders 5 Anxiety disorders 33·0 5·9 0·6 5 Diabetes 30·0 14·9 3·5
6 COPD 6 Diabetes 72·5 37·3 18·6 6 COPD 28·9 13·9 1·7
7 Blindness and vision impairment 7 Age-related hearing loss 44·9 15·3 0·7 7 Age-related hearing loss 25·7 11·1 0·2
8 Age-related hearing loss 8 Neck pain 45·7 16·0 0·8 8 Anxiety disorders 12·4 –0·7 –1·9
9 Neck pain 9 Blindness and vision impairment 41·8 12·9 –0·6 9 Neck pain 20·8 6·8 –1·5
10 Other musculoskeletal 10 COPD 19·1 –5·2 –17·7 10 Blindness and vision impairment 22·6 8·4 –2·1
11 Diabetes 11 Other musculoskeletal 50·0 19·4 7·0 11 Other musculoskeletal 21·2 7·1 0·9
12 Neonatal disorders 12 Neonatal disorders 52·7 21·5 26·8 12 Neonatal disorders 24·8 10·3 12·6
13 Gynaecological diseases 13 Gynaecological diseases 33·9 6·6 –2·5 13 Gynaecological diseases 10·2 –2·6 –2·3
14 Vitamin A deficiency 14 Oral disorders 38·1 9·9 –2·6 14 Oral disorders 22·1 7·9 –0·9
15 Oral disorders 15 Stroke 36·7 8·8 –6·4 15 Stroke 41·8 25·3 9·7
16 Falls 16 Falls 23·0 –2·1 –13·7 16 Falls 30·9 15·7 5·3
17 Stroke 17 Upper digestive diseases 32·3 5·3 –3·4 17 Upper digestive diseases 19·0 5·2 0·1
18 Dermatitis 18 Drug use disorders 30·6 3·9 0·8 18 Drug use disorders 18·3 4·6 5·3
19 Upper digestive diseases 19 Vitamin A deficiency –15·4 –32·7 –18·5 19 Schizophrenia 17·7 4·0 –0·2
20 Drug use disorders 20 Dermatitis 18·8 –5·5 –0·4 20 Dermatitis 11·9 –1·1 0·9
23 Schizophrenia 21 Schizophrenia 26 Vitamin A deficiency
Males
2 Headache disorders 2 Headache disorders 34·1 7·0 1·1 2 Headache disorders 15·5 2·6 1·5
3 Dietary iron deficiency 3 Diabetes 79·0 42·9 21·9 3 Diabetes 30·1 15·5 4·2
4 Depressive disorders 4 Depressive disorders 35·5 8·1 –0·1 4 Age-related hearing loss 24·2 10·2 –0·7
5 Age-related hearing loss 5 Age-related hearing loss 44·0 14·9 –0·1 5 Depressive disorders 14·8 1·9 –1·9
6 Diabetes 6 Neonatal disorders 51·5 20·9 27·3 6 Neonatal disorders 22·1 8·4 11·4
7 COPD 7 Dietary iron deficiency –1·1 –21·1 –15·1 7 Drug use disorders 21·5 7·9 7·9
8 Drug use disorders 8 COPD 32·6 5·8 –9·5 8 Blindness and vision impairment 23·6 9·7 –1·5
9 Blindness and vision impairment 9 Drug use disorders 34·8 7·6 4·5 9 COPD 17·9 4·7 –8·2
10 Other musculoskeletal 10 Blindness and vision impairment 36·2 8·7 –5·3 10 Other musculoskeletal 16·4 3·3 –2·9
11 Neonatal disorders 11 Other musculoskeletal 41·5 12·9 1·0 11 Neck pain 22·3 8·5 0·4
12 Neck pain 12 Neck pain 42·6 13·8 –0·9 12 Dietary iron deficiency –5·6 –16·2 –13·7
13 Anxiety disorders 13 Anxiety disorders 31·2 4·7 0·1 13 Anxiety disorders 13·6 0·8 0·0
14 Falls 14 Falls 23·1 –1·7 –11·4 14 Falls 25·0 11·0 3·1
15 Vitamin A deficiency 15 Alcohol use disorders 39·2 11·1 3·8 15 Stroke 46·0 29·6 13·1
16 Alcohol use disorders 16 Oral disorders 38·7 10·8 –2·4 16 Oral disorders 20·5 7·0 –1·8
17 Congenital anomalies 17 Congenital anomalies 22·5 –2·2 –0·5 17 Alcohol use disorders 7·9 –4·2 –6·3
18 Oral disorders 18 Stroke 44·4 15·3 –2·4 18 Other mental disorders 17·2 4·1 –0·1
19 Other mental disorders 19 Other mental disorders 36·8 9·2 –0·2 19 Schizophrenia 16·7 3·6 –0·4
20 Schizophrenia 20 Schizophrenia 37·7 9·9 –0·1 20 Congenital anomalies 12·0 –0·6 0·3
21 Stroke 24 Vitamin A deficiency 30 Vitamin A deficiency
Communicable, maternal, neonatal,
and nutritional diseases
Injuries
Figure 8: Leading 20 Level 3 causes of global YLDs for 1990, 2007, and 2017, with percentage change in number of YLDs and all age and age-standardised rates for each sex
Causes are connected by lines between time periods; solid lines are increases and dashed lines are decreases. For the time periods 1990–2007 and 2007–17, three measures of change are shown:
percentage change in the number of YLDs, percentage change in the all-age YLD rate, and percentage change in the age-standardised YLD rate. Communicable, maternal, neonatal, and nutritional
diseases are shown in red; non-communicable causes in blue; and injuries in green. Statistically significant changes are shown in bold. COPD=chronic obstructive pulmonary disease. YLDs=years lived
with disability.

For both males and females, the top two leading causes Discussion
of global YLDs remained consistent between both time Main findings
periods, during which the total number of YLDs for each While age-standardised all-cause global YLD rates
of these causes increased. The third top cause in 2017 decreased by less than 4% over the nearly three-decade
was depressive disorders for females and diabetes for period from 1990 to 2017, the number of total YLDs has
males. From 1990 to 2007, for females, the number of increased by more than 50% during this time. This
YLDs attributable to low back pain increased by pattern is concerning given the lack of substantial
29·8% (95% UI 27·7–31·8) and headache disorders improvement in age-standardised rates over time as well
increased by 34·0% (32·8–35·3). From 1990 to 2007, for as the increased magnitude of total health loss. These
females, the number of YLDs attributable to depressive patterns are probably related to population growth and
disorders increased by 32·2% (29·8–34·4), causing ageing as well as increasing numbers of YLDs from
depressive disorders to become the third leading cause in conditions such as type 2 diabetes and opioid use
2007. The number of YLDs for the three leading causes disorders, which were less common in 1990. YLD
for females continued to increase from 2007 to 2017, by increases, even when age-standardised rates are slightly
17·3% (15·8–18·8) for low back pain, 15·3% (14·4–16·2) improving, might pose a burden to economies and
for headache disorders, and 14·1% (12·8–15·5) for health-care systems that have not expanded proportionally
depressive disorders. From 1990 to 2007, for males, the to population growth or in populations where economic
number of YLDs attributable to the top two leading improvements have not been equitably distributed.
causes increased by 30·2% (28·1–32·2) for low back pain Globally, over the 28-year period studied, three chronic
and 34·1% (32·7–35·4) for headache disorders. From NCDs (low back pain, headache disorders, and depressive
1990 to 2007, for males, the number of YLDs attributable disorders) have prevailed as three of the top four leading
to diabetes increased by 79·0% (75·8–82·2), causing causes of YLDs, collectively causing 162 million (95% UI
diabetes to become the third leading cause. The number 118–216) YLDs in 2017 and representing nearly one in
of YLDs for the three leading causes continued to climb five YLDs globally. This substantial portion of global
from 2007 to 2017, increasing by 17·8% (16·5–19·3) for YLDs might be amenable to treatment and care access,
low back pain, 15·5% (14·5–16·5) for headache disorders, because headache disorders and depressive disorders
and 30·1% (24·8–36·1) for diabetes. can be treated with low-cost therapeutics. The persistence
Between 1990 and 2007, age-standardised YLD rates of depressive disorders and low back pain is also
for females decreased for the three leading causes: low concerning given the former’s relation with self-harm
back pain (by 7·6%, 95% UI 6·2 to 8·9), headache and the latter’s relation with potential loss of functional
disorders (by 0·1%, −0·80 to 0·69), and dietary iron status in the work force.
deficiency (by 18·8%, 17·0 to 20·7). Between 1990 and
2007, the YLD rate for depressive disorders decreased by Emerging trends
3·0% (1·6 to 4·5) and became the third leading cause of For the first time in the GBD study, we estimated the
YLDs in females in 2007 due to the simultaneous large burdens of type 1 and type 2 diabetes separately. Our
decrease in dietary iron deficiency (figure 8A). Between estimates illustrate the emergence of diabetes as a leading
1990 and 2017, YLD rates for females decreased for low cause of disability globally, ranking as the fourth leading
back pain (by 10·1%, 95% UI 8·8 to 11·3), depressive cause of age-standardised YLDs in 2017. This increased
disorders (by 6·0%, 5·0 to 7·1), and dietary iron burden was observed across all levels of development.
deficiency (by 30·7%, 27·4 to 33·7), while headache Age-standardised YLDs increased for both females and
disorders increased by 0·6% (−0·19 to 1·42). Between males across all SDI quintiles between 1990 and 2017
1990 and 2007, the YLD rates for males decreased for (figure 3). Diabetes poses complicated care challenges
low back pain (6·8%, 5·6 to 7·8) and dietary iron even in areas with reliable access to medical services.
deficiency (15·1%, 10·9 to 18·9), and increased for Preventive measures such as pre diabetes screening,
headache disorders (1·1%, 0·15 to 1·9). Between 1990 lifestyle modification, and treatment with low-cost
and 2007, the YLD rate for diabetes increased by 21·9% medications such as metformin could avert worsening
(20·0 to 24·0) and became the third leading cause of incidence rates, but as prevalence increases, health-care
YLDs in males in 2007. From 2007 to 2017, the YLD rate systems will also need to provide access to services such as
for headache disorders increased by 1·5% (0·8 to 2·3) wound care, surgical resources, medications including
and that for diabetes increased by 4·2% (0·0 to 8·7), insulin, care for diabetic retinopathy, and increased focus
whereas the YLD rate for low back pain decreased by on heightened cardiovascular disease risk.
1·3% (0·7 to 1·9). Between 1990 and 2017, the YLD rate This is also the first year of GBD estimation for non-
for low back pain decreased by 8·0% (6·9 to 9·1) and alcoholic fatty liver disease (NAFLD) and cirrhosis and
that for dietary iron deficiency decreased by 26·7% liver cancer caused by non-alcoholic steatohepatitis
(20·6 to 32·5), whereas the rates for headache disorders (NASH). For cirrhosis and liver cancer caused by NASH,
and diabetes increased by 2·6% (1·6–3·6) and 27·0% we estimated 892 million (95% UI 859–928) global
(22·2–32·4), respectively. cases for cirrhosis due to NASH and 97 400 cases

(86 800–108 000) for liver cancer due to NASH, and an of pneumococcal pneumonia and rotavirus diarrhoea
age-standardised prevalence of 11 061 cases (10 651–11 493) are notable given the availability of vaccines for these
per 100 000 for cirrhosis due to NASH and 1·20 cases pathogens, highlighting the need for continued expan
(1·07–1·33) per 100 000 for liver cancer due to NASH in sion of vaccine coverage and delivery systems.
2017 (appendix 2), identifying NASH as an increasingly While the burden of musculoskeletal disorders, vision
important cause of liver disease. We observed that these loss, and hearing loss in older ages has been a consistent
cases were distributed across all GBD regions, although theme in past GBD studies due to their substantial
more commonly in North Africa and the Middle East contribution to non-fatal health loss, the burden of
and in Oceania in terms of age-standardised rates. medically complex, high-resource conditions has also
This expansion of NAFLD and liver disease due to become increasingly concerning. Cardiovascular disease,
NASH reflects the worsening burden of metabolic chronic respiratory conditions, and neurological disorders
conditions globally. Given the complexity of chronic liver sum to form more than 15% of age-standardised YLDs in
disease and the difficulty of effectively treating obesity, every GBD region except two (southern Latin America
efforts to prevent obesity and to develop therapeutics for and eastern sub-Saharan Africa; appendix 2). GBD risk
NAFLD will be increasingly important. factor estimates show that the drivers for atherosclerotic
After initial steep reductions in HIV incidence between cardiovascular diseases—high systolic blood pressure,32–34
1998 and 2005, the global rate of decline in new HIV high cholesterol, poor diet,35 high fasting plasma glucose,35
infections continues, although it has slowed in recent and low physical activity36—prevail in many geographies,
years and global prevalence has increased slightly since indicating that this burden can be expected to persist and
2010, a trend which is probably driven by rapid expansion possibly expand as populations age. While the efforts of
of antiretroviral therapy in high-prevalence countries and primary prevention approaches such as statin therapy and
extended life expectancy of people living with HIV. These smoking cessation are evident in the gradual declines in
longer lifespans call for increased resources for treatment age-standardised prevalence in high-income countries
and continued prevention and treatment interventions to over the past 28 years, the prevalence of cardiovascular
maintain declines in incidence.27 For tuberculosis, it is a disease in these populations still remains high, which
notable success that drug-susceptible tuberculosis has might also reflect improved survival from acute events
declined in terms of age-standardised incidence since due to improved response systems and interventions such
1990. The burden of malaria has also declined since the as percutaneous coronary intervention, coronary artery
mid-2000s in terms of age-standardised incidence rates. bypass grafting, and rapid stroke treatment guidelines,37–40
High age-standardised incidence rates of acute viral as well as secondary prevention with statins, anti
hepatitis have persisted, however, with age-standardised hypertensives, and smoking cessation.41–46 As developing
incidence rates of hepatitis A and B combined exceeding economies increasingly experience cardiovascular disease
malaria incidence in 2017 despite availability of vaccines. burden, investing in health system infrastructure to
The age-standardised incidence rate of acute hepatitis ensure access to these interventions as well as to primary
did not significantly change from 1990 to 2007, from 2007 prevention therapeutics could help to mitigate disability
to 2017, or from 1990 to 2017, suggesting that more and improve survival into older ages.40,47,48 Chronic
proactive global initiatives are important, particularly respiratory conditions also inflict considerable health loss
with respect to vaccine coverage28 and cost-effective in older people, contributing to more than 5% of YLDs
access to hepatitis C curative treatments.29–31 starting in the 50–54 year age group, globally, who were
Incidence rates of lower respiratory infections (LRIs) exposed to risk factors such as smoking and indoor air
declined among children younger than 5 years by pollution and similarly pose challenges to health systems
32·4% (95% UI 27·2–37·5) since 1990 and caused with ageing populations, given the importance of oxygen
83·0 million (66·4–101) episodes in children younger therapy,49–52 access to medical care,53–55 and the risk of
than 5 years in 2017, while the age-standardised incidence respiratory infections among these patient populations.56,57
rate decreased by 5·8% (1·5–10·0) between 1990 and Neurological conditions continue to show large numbers
2017 (appendix 1). Among all ages, pneumococcal of prevalent cases and YLDs, with consistent increases in
pneumonia has prevailed as the leading aetiological recent years. We anticipate that this burden will also
subtype of LRI, accounting for more than five times expand as populations age, creating challenges for health-
more YLDs than the second leading cause (influenza). care systems given the lack of modifiable risk factors for
Diarrhoeal episodes have persisted as the second most some neurological conditions and effective treatments
common incident cause of health loss after upper for conditions such as Alzheimer’s disease. Given the
respiratory infection among all ages, with 6·29 billion extensive care requirements these conditions—in iso
(5·81–6·82) total episodes in 2017, with rotavirus pre lation or as comorbidities—demand from both health
vailing as the leading aetiology. The age-standardised systems and social and familial supports, their morbidity
incidence of diarrhoea varied nine-fold across GBD can reflect not only diminished health for an individual
regions, with the lowest rates in Australasia and the and population but also lost capital in an economy and
highest rates in Oceania (appendix 2). The burdens among caretakers.58–63

Opioid use disorders including opioid dependence These observations imply that health systems might
have become an era-defining epidemic in the USA with have achieved improvements in non-fatal burden that
more than 4 million prevalent cases in 2017. Outside the have not been shared across sexes. The underlying
USA, opioid dependence was estimated to cause more reasons for these imbalances are likely to be complex.
than 1% of age-standardised YLDs in 135 countries in For causes that are inherently more common in males
2017, whereas in 12 out of 21 GBD regions, more than or females, improvements in one sex over the other
5% of YLDs in the 15–49 year age group were caused by might reflect these causes differing in susceptibility to
substance use disorders overall (appendix 2). Cumu prevention, intervention, and treatment. For example,
latively, these results show pervasive health loss from autoimmune conditions such as rheumatoid arthritis
substance use, which might also cause lost human can affect both males and females but are ordinarily
capital given the concentration of the burden in working more common in females.64,65 However, such a cause still
ages. The burden of mental disorders is present in leads to increased disability that might also have
both sexes and across all age groups after emerging ramifications not captured in a health study, such as
in childhood with idiopathic intellectual disability income loss due either to disability at young ages or to
and autism spectrum disorders and continuing into the cost of modern immunotherapies. Similarly, females
older ages with depressive disorders, anxiety disorders, of childbearing age experience risk of pregnancy-related
and schizophrenia. Mental disorders have consistently and maternal conditions, risks that could be pronounced
formed more than 14% of age-standardised YLDs in lower-resource settings without sufficient access to
for nearly three decades, and have greater than modern obstetric facilities and follow-up care.66,67 Other
10% prevalence in all 21 GBD regions. These findings causes have firmly established causal risk factors such as
substantiate a global need for increased mental health smoking and chronic obstructive pulmonary disease
and substance abuse treatment re sources, improved (COPD), where the higher COPD rates in males are
judiciousness of opioid prescribing patterns particu probably due to historically higher rates of smoking
larly for chronic pain, and expanded harm-reduction compared with females. Additionally, some causes
strategies such as opioid substitution therapy and may be susceptible to systematic misdiagnosis due to
needle programmes. conventional clinical heuristics based on flawed or non-
existent evidence. For example, in some areas, females
Cross-cutting themes presenting with acute coronary syndrome are more
Among the 22 causes in the Level 2 GBD cause hierarchy, commonly misdiagnosed,68 whereas other causes, such
14 causes had a relative difference between males and as autism spectrum disorders, might be systematically
females greater than or equal to 10% in terms of prevalent underdiagnosed in females compared with males.69–71
cases in 2017, while 12 causes had a relative difference These biases in sex-specific misdiagnosis emphasise the
greater than 10% in terms of age-standardised prevalence. need for continued refinement in sex-specific burden
Notably, females had significantly higher prevalence of estimation.
HIV/AIDS and sexually transmitted infections (driven While YLD rates are highest in older ages, globally,
primarily by higher burden from sexually transmitted YLD counts are heavily concentrated in working-age
infections) and self-harm and interpersonal violence, males and females (ie, from 20–54 years), a pattern which
among other causes, whereas males had significantly is particularly evident among causes such as mental
higher prevalence of substance use disorders and trans disorders, neurological disorders, and musculoskeletal
port injuries, among other causes. Figure 6 illustrates disorders, which sum to more than 45% of all YLDs in
how divergent trends were nearly evenly distributed these age groups. This finding is notable for two main
between males and females, despite the overall higher reasons. First, these age groups have a considerable
numbers of YLDs experienced by females. As indicated number of years to live that would otherwise be in full
by the higher Z score in female-favourable causes, the health, emphasising how conditions at these ages, even
cause-regions where females did better over time tended if having lower disability weights, can still contribute
to have greater improvements in age-standardised YLD substantially to the non-fatal burden. Second, a disabling
rates than did the cause-regions where males did better condition that occurs during this period of life could
over time. There were important exceptions, however: represent lost human capital. This loss will be
for example, with HIV/AIDS and sexually transmitted increasingly important to characterise with human
infections in central sub-Saharan Africa, the age- capital emerging as an important area of focus at the
standardised YLD rates for females increased by 30·0% World Bank.72,73
(95% UI 6·8–68·1), while rates for males decreased In GBD 2017, anaemia is classified as an impairment,
by 43·0% (23·2–58·5) between 1990 and 2017. This with aetiologies ranging from rare genetic haemoglobino
particular trend reveals a striking lapse in health equity pathies to iron deficiency. Because these aetiologies
given the extensive knowledge of treatment and alone could cause a relatively small proportion of all
prevention methods for HIV/AIDS and many sexually anaemia cases, the magnitude of anaemia’s burden
transmitted infections. would be obscured by the granularity of these aetiologies

if it was not also estimated in aggregate. In 2017, the sum greater than the GBD 2017 estimate of 94·5 million
of YLDs across all causes of anaemia was 58·2 million (79·5–112). These two studies are part of the Maternal
(95% UI 39·5–83·0), with a global age-standardised rate and Child Epidemiology Estimation (MCEE). The MCEE
of 783·9 YLDs (531·3–1117·8) per 100 000 for both sexes, methodology for diarrhoea and pneumonia incidence
with sex-specific rates of 1012·8 YLDs (689·4–1436·5) per differs from GBD in that MCEE uses only community-
100 000 females, and 555·9 YLDs (370·4–801·8) per based studies. By contrast, the GBD uses a greater
100 000 males. Globally, in terms of YLD rates in 2017, volume of data including Demographic and Health
anaemia is the leading impairment for females, males, Surveys, Multiple Indicator Cluster Surveys, and clinical
and both sexes combined. If anaemia were treated as a data records. We also used diarrhoea-specific and LRI-
cause, it would rank as the fourth leading Level 2 cause specific summary exposure values as covariates in our
and as the first leading Level 3 cause in terms of age- models, which include location-specific and year-specific
standardised YLD rates globally for females in 2017. The estimates of risk factors associated with diarrhoea or LRI.
third leading impairment for males, females, and both We observed that these covariates had significant
sexes combined was blindness and vision impairment relationships with diarrhoea and LRI incidence rates and
(1·34 billion [1·29–1·39] cases in 2017), which is notable therefore strengthened our estimates, particularly in
given the economic consequences of vision loss,74,75 the data-sparse areas. Further modelling details are described
relative treatability of many vision loss conditions, and in the supplementary methods (appendix 1 section 4).
the increased risk of injury that stems from visual For HIV/AIDS, we used new methods to adjust for
impairment.76,77 Summed together, the impairments representativeness bias in ANC surveillance data,83 which
included in the GBD cause hierarchy comprise a total of led to our models predicting a lower peak and flatter
more than 5 billion prevalent cases worldwide in 2017, trend of the epidemic in southern sub-Saharan Africa
making it evident that health-care systems and policy compared with GBD 2016. We updated our inputs of
makers should evaluate non-fatal burden not only for antiretroviral therapy coverage distribution informed by
diseases and injuries but also for impairments and their data from the International Epidemiology Databases to
aetiologies. Evaluate AIDS and CD4+ progression parameters for
children.84,85 We also improved our sex-specific modelling
Important changes in GBD 2017 compared with strategy in Spectrum by sex-splitting incidence based on
GBD 2016 a model fit to the sex ratio of prevalence observed in
Overview countries with representative surveys. Our estimated
Overall, the most important systemic change to this year’s global prevalence results are similar to UNAIDS 2017
study is the estimation of population and fertility in the values, with some variation at the national level.
GBD framework. In addition, we made changes to the Estimates in recent years are expected to be less stable
GBD cause hierarchy (for example adding an aggregate due to improvements in HIV treatment coverage and
Level 3 headache disorders cause), which limits certain prevention. Further modelling details are described in
cause-specific comparisons with past GBD cycles; this is the supplementary methods (appendix 1 section 4).
discussed in more detail in the Limitations section below. The hepatitis estimation process has changed to
Other notable cause-specific considerations, comparisons, improve internal consistency between mortality and non-
and limitations that are new as of GBD 2017 are as fatal estimates for GBD 2017. First, we included case-
follows. More details for each cause can be found in the fatality rates from clinical data in our mortality models to
supplementary methods (appendix 1 section 4). improve the distribution of hepatitis deaths by virus.
Second, we developed a time series of hepatitis B
Cause-specific considerations, comparisons, and limitations virus vaccine coverage in infants to use as a covariate.
In GBD 2017, we added the Malnutrition and Enteric Third, the aggregate cause-specific mortality rate of acute
Disease (MAL-ED) study to our existing use of the Global hepatitis, cirrhosis, and liver cancer due to hepatitis B
Enteric Multicenter Study (GEMS)78–80 to measure diar and hepatitis C was combined with virus-specific sero
rhoeal aetiologies, which affected our aetiological prevalence data to ensure internal consistency among
distributions with increased norovirus and rotavirus incidence, prevalence, remission, and excess mortality
attributions. Our overall diarrhoea incidence estimates rates. Fourth, the prevalence of chronic hepatitis B and C
were not affected. The Walker and colleagues’ study81 are now captured in the cirrhosis and other chronic liver
estimated 1·7 billion episodes of diarrhoea among diseases cause group rather than in the prevalence
children younger than 5 years in 2010, a value that is estimates for acute hepatitis B and acute hepatitis C.
greater than the GBD 2017 estimate in the same year Overall, this caused prevalent cases of hepatitis B and C to
(1·16 billion, 95% UI 1·00–1·34). For pneumonia, a study be shifted from the acute hepatitis B and C causes to
by Rudan and colleagues82 estimated a global pneumonia the cirrhosis and other chronic liver diseases cause.
incidence of 0·22 episodes (IQR 0·11–0·51) per child- Specifically, in terms of global age-standardised prevalence
year among children younger than 5 years in 2010, rates for both sexes in 2016, acute hepatitis B decreased
accounting for 122·6 million episodes, a value that is from 6295 cases (95% UI 5349–7436) per 100 000 in GBD

2016 to 219 cases (193–248) per 100 000 in GBD 2017, while NASH and NAFLD
its corresponding chronic cause, cirrhosis and other In GBD 2017, for the first time we estimated NASH as a
chronic liver diseases due to hepatitis B, increased from cause of liver cancer and cirrhosis and NAFLD as an
170 cases (159–184) to 5625 cases (5159–6118) per 100 000. asymptomatic health state. Our global age-standardised
Similarly, acute hepatitis C decreased from 2152 cases prevalence estimate of NAFLD and NASH that leads
(1927–2382) per 100 000 in GBD 2016 to 8·11 cases to cirrhosis or liver cancer was 10 935 cases (95% UI
(7·37–8·98) per 100 000, while its corresponding chronic 10 522–11 365) per 100 000 in 2017, which was lower than
cause, cirrhosis and other chronic liver diseases due to a study by Younossi and colleagues,86 which estimated a
hepatitis C, increased from 149 cases (136–164) to global prevalence of 24%. This difference is due to how
1723 cases (1517–1969) per 100 000 (appendix 2). we adjust for alcohol use in the population, which helps
to distinguish these conditions from alcohol-driven liver
Maternal, neonatal, and child health disease. Our study shows a similar geographical pattern
Several changes were adopted for GBD 2017. Adding to the Younossi study, with higher rates in North America
clinical and claims records from outside the USA to and the Middle East, corresponding to higher rates
our models affected congenital birth defects, haemo of obesity.
globinopathies, and maternal disorders. Updating our
inpatient admission per-capita estimates to include in- Cardiovascular diseases
facility deliveries as a newborn admission affected neonatal We split haemorrhagic stroke into subarachnoid
disorders and congenital birth defects. Adopting in-facility haemor rhage and intracerebral haemorrhage as sub
delivery estimates for processing clinical data for maternal types of stroke and added non-rheumatic valve disease
disorders led to lower estimates of pregnancy compli as an additional cause and aetiology of heart failure. The
cations, especially in high-utilisation settings. We refined overarching limitation in cardiovascular estimation is
our method for estimating age-specific preterm birth and that low-income and middle-income locations are less
its complications to be consistent with GBD risk factor likely to have diagnostic tests such as treadmill tests,
analysis, which resulted in preterm birth prevalence being ankle-brachial index measurement, and other modern
higher than in previous GBD estimates. We enforced diagnostics. This also limits the identification of
internal consistency among our estimates such that, for preclinical atherosclerotic disease for individuals who
example, the sum of all specific types of congenital heart have not had clinical events but who might have
disease must equal the total number of cases of congenital ischaemic changes with provocative cardiac testing. For
heart disease. These methodological changes have lowered stroke, there were few sources of incidence data in
global estimates for many of the specific causes of birth many low-income and middle-income countries, and
defects, enforced the internal consistency of mortality and many clinical records used the ICD code for “acute,
non-fatal estimates, narrowed the unexplained geo unspecified stroke”, which does not differentiate
graphical variation in disease incidence, and strengthened between ischaemic stroke, intracerebral haemorrhage,
the empirical re lationship with known environmental, and subarachnoid haemorrhage. Future incorporation
nutritional, and behavioural determinants of these con of more clinical record data might help to address these
ditions. For nutri tional deficiencies, we extended our limitations by providing more diagnostic detail for
analysis of protein-energy malnutrition past age 5 years, cause subtypes.
incorporated cause-specific mortality rates, and included
the prevalent cases of moderate wasting without oedema. Chronic respiratory diseases
Although the net result might seem to be an increase in We added several data sources that had lower estimates
the number of protein-energy malnutrition cases, it than the International Study of Asthma and Allergies in
instead reflects a more comprehensive assessment of Childhood studies, which were the main source of
acute malnutrition than was estimated previously. asthma prevalence previously. Additionally, the adjust
ment factor for studies reporting on physician-diagnosed
Diabetes asthma without an additional question on wheezing
Diabetes has been estimated in previous GBD studies, changed between GBD 2016 and GBD 2017 after new
but this is the first year that type 1 and type 2 diabetes data sources were added.
were estimated and reported separately. The estimation
strategy for diabetes is provided in more detail in the Neurological conditions
supplementary methods (appendix 1 section 4), but in For dementia, we added covariates for whether studies
summary, we measured overall diabetes and type 1 had common features present in their diagnostic protocol,
diabetes. We subtracted estimates of type 1 from overall such as a review of clinical records or a diagnosis by a
diabetes to produce estimates for type 2 diabetes. One of clinician to try to correct for some of the heterogeneity
the main limitations to measuring type 2 diabetes is that between studies, because only a very small fraction of
surveys of diabetes in adults do not make a distinction studies used the same methods. We do not have reliable
between cases of type 1 and type 2 diabetes. covariates for prevalence or incidence of dementia and

other neurological disorders, although in future studies, data density for each Level 1 location-cause combination
estimates of neurological disorders will benefit from the in the GBD study. Data availability does not consistently
increased use of clinical and claims records. correlate with burden—that is, high-burden causes and
locations can have relatively sparse data for non-fatal
Cancer outcomes. This will also be increasingly problematic
For GBD 2017, we added the new cause “myelodysplastic, as more countries start to experience greater burden
myeloproliferative, and other haemopoietic neoplasms”, from NCDs.
which were previously estimated as part of the “other Currently, we inform most of the severity distributions
neoplasms” group. In addition, we added new causes that affect YLD calculation using the Medical Expenditure
for three categories of benign and in-situ neoplasms: Panel Survey from the USA. This poses a limitation as
intestinal, cervical and uterine, and other. the severities experienced in this population probably do
not reflect global severity distributions or reflect that
Mental and substance use disorders severity distributions are likely to vary over time, location,
We estimated burden for a combined group of autism age, and by treatment access. As such, YLDs estimated
spectrum disorders consistent with the Diagnostic and might not reflect improvements in disability over time as
Statistical Manual of Mental Disorders 5 designations in SDI increases. Even for the limited diseases such as
GBD 2017 as opposed to separately estimating autism COPD, epilepsy, and stroke for which data from epi
and Asperger’s syndrome and other autism disorders.87 demiological studies allow us to differentiate severity by
Modelling improvements were made for opioid use age, time, and location, the underlying data sources are
disorders by incorporating new country-level covariates, still extremely limited in coverage by age, time, and
including a measure of opioid analgesic consumption by location. Relying on published data on severity is unlikely
country and the prevalence of injection drug use. to provide improved estimates in the near future. We also
Enhancements in the fatal modelling of opioid use plan to access linked data between administrative records
disorders also contributed to these improved estimates. with diagnostic information and health surveys using
Improvements were also made in terms of data additions, health status measures to quantify severity of disease and
particularly for cocaine and amphetamine dependence, how this changes over time and by age and sex.
where new data showed greater subnational variation in Comorbidity adjustment in GBD 2017 assumes inde
Mexico and Brazil. pendent distributions of comorbid conditions. This is a
limitation because comorbidity distributions are known
Injuries to vary by cause, age, sex, location, and time. For example,
For GBD 2017, improvements were made to the com diabetes and cardiovascular disease are more likely to be
putational framework required for injuries non-fatal comorbid than asthma and gynaecological disorders but
measurement. These updates included incorporating currently our comorbidity adjustment does not capture
GBD 2017 age groups and updating the differential these correlations.
equation solver for converting incidence to prevalence. Clinical data records have known selection bias for
Poisoning was divided into the two subcauses of subsets of the population that have access to health care.
poisoning by carbon monoxide and poisoning by other Some GBD causes rely heavily on clinical data given the
agents. Our estimate of 172 million (95% UI 152–194) lack of other sources, with efforts made to correct for this
falls per year resulting in any short-term or long- bias by using representative studies as a reference group.
term disability was higher than those of WHO, which In recent years, the GBD study has used USA claims
estimated 37 million falls88 that required medical records to inform hospital data adjustments and various
attention per year—a difference that might be explained other elements of GBD estimation. Relying on data from
by GBD’s inclusion of a wide spectrum of injury a privately insured cohort in a high-income country
severities including minor injuries that result from falls. poses limitations to the generalisability of these adjust
The WHO and GBD estimates on road injuries were ments. This year, we also used tabulated claims records
more similar, with WHO estimating 20–50 million from Taiwan (province of China) for the first time in the
people experiencing non-fatal road injuries per year89 and GBD study, and in future publications we plan to
GBD 2017 estimating 54·2 million (47·4–61·6) road continue incorporating claims data from additional
injuries in 2017. For fires, WHO and GBD 2017 had countries to address this limitation. Acquiring further
similar estimates when comparisons were available—for health insurance claims data will not only inform
example, in the USA, WHO reported 410 000 burn estimates in terms of incidence and prevalence measures
injuries90 in 2008 and GBD 2017 reported 360 000 but will also help to develop more accurate parameters
(313 000–380 000) fire, heat, and hot substance injuries. that affect GBD estimates in other modelling steps.
With regard to age-time patterns, in DisMod-MR 2.1,
Limitations we start by estimating a global model that uses all the
As is evidenced in figure 1 and the supplementary available data and covariates with hierarchical random
methods, there is considerable heterogeneity in terms of effects for geographies to estimate a prior distribution

that is passed down the geographical cascade. Time improvements have been suggested by the GBD collab
trends in our estimates result from where the covariates orator network and the global research community, and
are changing over time, when year is included as a the following future directions are planned to be
covariate or when data in different time periods lead incorporated in the coming cycles.
to variation in the posterior estimates. This frame Because the GBD cycle continues to be published on
work, however, does not capture true cohort effects. an annual basis, it will be important to incorporate
For example, we do not directly take into consideration updated data sources for older estimation years but also
prevalence in 30-year-olds in 1990 when estimating to add sources for the most recent estimation year. This
prevalence in 50-year-olds in 2010. This is a limitation for necessitates data inclusion immediately after the end of
some diseases with known cohort effects such as the the calendar year in order to be incorporated for the
high incidence of hepatitis C in the USA in younger following year’s estimation. This is challenging because
adults in the 1970s. We are continuing to develop a some surveys, surveillance systems, and literature
version of DisMod that explicitly incorporates a full age- studies have a lag period between data collection and
time-period model in a Bayesian framework that will publication. One solution to this challenge would be
help to address this issue. adding, updating, and incorporating clinical data records
While our cause list currently specifies 354 diseases from inpatient and outpatient visits from hospitals
and injuries, there is great interest in incorporating a and clinics from more locations. Clinical data provide a
greater level of detail. Going forward, we intend to level of detail, demographic information, and diagnostic
become more granular in our cause list, but every new accuracy that enhances the GBD study’s ability to
disease requires a substantial amount of new reviews produce accurate estimates in the more recent estimation
and model building. In consultation with our Scientific years. Relying more heavily on clinical data will require
Council, we will need to balance our available resources improved methods for adjusting for known repre
with this growing list of priorities for new additions. sentativeness biases. In the future, we plan to link
Similar to the cause reporting list, the hierarchy of the medical records to representative survey results, which is
cause list and the method by which conditions are possible with certain claims databases such as the
classified and grouped is a complex component of the Medicare Current Beneficiary Survey in the USA.93
GBD framework that has undergone nearly continuous In the next iteration of the GBD study, we plan to
improvement and refinement in years past. Grouping incorporate improved age-time estimation using a new
GBD causes into broad cause groups is a necessary part tool, DisMod-AT, that simultaneously quantifies the
of the study’s estimation and reporting process, but it relationships over time, by age, and by age cohorts.
can also cause limitations and challenges in the absence DisMod-AT will address the age-time measurement
of broad consensus on objective frameworks for limitation described above.
organising cause hierarchies. Other studies that measure We plan to continue updating and refining our cause
burden of disease exemplify how disease groupings can and location hierarchies including the causes described
affect a study’s implications and interpretation. A recent above. This is the first year that estimates for a non-geo
study91 cited medical errors as the third leading cause graphical subnational grouping (ie, Māori and non-Māori
of death in the USA but grouped all heart disease and populations in New Zealand) were modelled, and in
all cancer as the first and second leading causes, future GBD studies it would be compelling to similarly
respectively. A different aggregation or level of detail in estimate disease burden in groups within a location not
terms of the disease grouping in such a study could strictly determined by geographies—for example, race
change these rankings, which become important in the groups within the USA or refugee populations in host
realm of health policy and resource allocation as well as countries.
popular and political perception of what causes death
and disability in a population. In the GBD study, we have Conclusion
strived to retain as much detail as is methodologically The global burden of non-fatal health loss in 2017
possible given available data, and additionally we have represents a complex culmination of nearly three decades
incorporated input from the GBD collaborator network of evolving disease patterns and risk factor profiles,
in terms of refining our cause hierarchy to represent a improving health care, and dynamic populations. This
heterogeneous mix of medical specialties, research study provides comprehensive updates from prior GBD
expertise, and location-specific knowledge. In addition, studies and identifies topical themes that can be used to
our framework allows us to revise the cause hierarchy guide future research and discussion in the arena of non-
for specific specialties such as the burden of neurological fatal health loss. Continuing a trend from throughout
disorders.92 the history of the GBD study, we show how YLDs
continue to increase as countries improve along the
Future directions development spectrum and emphasise how economies
The methods and data that inform YLD estimation in the should anticipate difficulties in caring for older popu
GBD study will continue to evolve. Several specific lations suffering from complex conditions such as

diabetes, respiratory and cardiovascular diseases, and Austin Carter, Félix Carvalho, Carlos A Castañeda-Orjuela,
neurological conditions. Additionally, we report hetero Jacqueline Castillo Rivas, Franz Castro, Ferrán Catalá-López,
Kelly M Cercy, Ester Cerin, Yazan Chaiah, Alex R Chang,
geneity in outcomes experienced across different sexes, Hsing-Yi Chang, Jung-Chen Chang, Fiona J Charlson,
geographies, and income levels, and identify regions and Aparajita Chattopadhyay, Vijay Kumar Chattu, Pankaj Chaturvedi,
causes where sexes have had divergent health trends over Peggy Pei-Chia Chiang, Ken Lee Chin, Abdulaal Chitheer,
time. These findings should help to focus prevention Jee-Young J Choi, Rajiv Chowdhury, Hanne Christensen,
Devasahayam J Christopher, Flavia M Cicuttini, Liliana G Ciobanu,
and treatment efforts on groups and areas that have Massimo Cirillo, Rafael M Claro, Daniel Collado-Mateo, Cyrus Cooper,
experienced inequitable health outcomes. Continuing Josef Coresh, Paolo Angelo Cortesi, Monica Cortinovis, Megan Costa,
the theme of health equity, we highlight the extensive Ewerton Cousin, Michael H Criqui, Elizabeth A Cromwell, Marita Cross,
amount of health loss experienced globally for conditions John A Crump, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona,
Paul I Dargan, Ahmad Daryani, Rajat Das Gupta, José Das Neves,
that are treatable or preventable such as viral hepatitis, Tamirat Tesfaye Dasa, Gail Davey, Adrian C Davis,
emphasising the profound impact that health-care Dragos Virgil Davitoiu, Barbora De Courten, Fernando Pio De La Hoz,
systems can produce with increasing investment in and Diego De Leo, Jan-Walter De Neve, Meaza Girma Degefa,
access to health-care resources. Finally, we emphasise Louisa Degenhardt, Selina Deiparine, Robert P Dellavalle,
Gebre Teklemariam Demoz, Kebede Deribe, Nikolaos Dervenis,
the burden of non-fatal health loss in younger and Don C Des Jarlais, Getenet Ayalew Dessie, Subhojit Dey,
middle ages, where it is speculated that non-fatal health Samath Dhamminda Dharmaratne, Mesfin Tadese Dinberu,
loss could ultimately lead to loss in human capital. M Ashworth Dirac, Shirin Djalalinia, Linh Doan, Klara Dokova,
David Teye Doku, E Ray Dorsey, Kerrie E Doyle, Tim Robert Driscoll,
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken,
Spencer L James, Degu Abate, Kalkidan Hassen Abate, Solomon M Abay, Bruce B Duncan, Andre R Duraes, Hedyeh Ebrahimi,
Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Soheil Ebrahimpour, Michelle Marie Echko, David Edvardsson,
Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Andem Effiong, Joshua R Ehrlich, Charbel El Bcheraoui,
Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Zegeye Abebe, Maysaa El Sayed Zaki, Ziad El-Khatib, Hajer Elkout, Iqbal R F Elyazar,
Semaw F Abera, Olifan Zewdie Abil, Haftom Niguse Abraha, Ahmadali Enayati, Aman Yesuf Endries, Benjamin Er, Holly E Erskine,
Laith Jamal Abu-Raddad, Niveen M E Abu-Rmeileh, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati,
Manfred Mario Kokou Accrombessi, Dilaram Acharya, Pawan Acharya, Sadaf Esteghamati, Hamed Fakhim, Vahid Fallah Omrani,
Ilana N Ackerman, Abdu A Adamu, Oladimeji M Adebayo, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi,
Victor Adekanmbi, Olatunji O Adetokunboh, Mina G Adib, Talha A Farid, Carla Sofia E sá Farinha, Andrea Farioli, Andre Faro,
Jose C Adsuar, Kossivi Agbelenko Afanvi, Mohsen Afarideh, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Netsanet Fentahun,
Ashkan Afshin, Gina Agarwal, Kareha M Agesa, Rakesh Aggarwal, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes,
Sargis Aghasi Aghayan, Sutapa Agrawal, Alireza Ahmadi, Joao C Fernandes, Alize J Ferrari, Garumma Tolu Feyissa, Irina Filip,
Mehdi Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Florian Fischer, Christina Fitzmaurice, Nataliya A Foigt, Kyle J Foreman,
Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, Jack Fox, Tahvi D Frank, Takeshi Fukumoto, Nancy Fullman,
Tomi Akinyemiju, Nadia Akseer, Ziyad Al-Aly, Ayman Al-Eyadhy, Thomas Fürst, João M Furtado, Neal D Futran, Seana Gall,
Hesham M Al-Mekhlafi, Rajaa M Al-Raddadi, Fares Alahdab, Morsaleh Ganji, Fortune Gbetoho Gankpe, Alberto L Garcia-Basteiro,
Khurshid Alam, Tahiya Alam, Alaa Alashi, Seyed Moayed Alavian, William M Gardner, Abadi Kahsu Gebre, Amanuel Tesfay Gebremedhin,
Kefyalew Addis Alene, Mehran Alijanzadeh, Reza Alizadeh-Navaei, Teklu Gebrehiwo Gebremichael, Tilayie Feto Gelano,
Syed Mohamed Aljunid, Ala’a Alkerwi, François Alla, Peter Allebeck, Johanna M Geleijnse, Ricard Genova-Maleras,
Mohamed M L Alouani, Khalid Altirkawi, Nelson Alvis-Guzman, Yilma Chisha Dea Geramo, Peter W Gething, Kebede Embaye Gezae,
Azmeraw T Amare, Leopold N Aminde, Walid Ammar, Keyghobad Ghadiri, Khalil Ghasemi Falavarjani,
Yaw Ampem Amoako, Nahla Hamed Anber, Catalina Liliana Andrei, Maryam Ghasemi-Kasman, Mamata Ghimire, Rakesh Ghosh,
Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Aloke Gopal Ghoshal, Simona Giampaoli, Paramjit Singh Gill,
Mustafa Geleto Ansha, Carl Abelardo T Antonio, Palwasha Anwari, Tiffany K Gill, Ibrahim Abdelmageed Ginawi, Giorgia Giussani,
Jalal Arabloo, Antonio Arauz, Olatunde Aremu, Filippo Ariani, Elena V Gnedovskaya, Ellen M Goldberg, Srinivas Goli,
Bahram Armoon, Johan Ärnlöv, Amit Arora, Al Artaman, Hector Gómez-Dantés, Philimon N Gona, Sameer Vali Gopalani,
Krishna K Aryal, Hamid Asayesh, Rana Jawad Asghar, Zerihun Ataro, Taren M Gorman, Alessandra C Goulart, Bárbara Niegia Garcia Goulart,
Sachin R Atre, Marcel Ausloos, Leticia Avila-Burgos, Ayman Grada, Morgan E Grams, Giuseppe Grosso,
Euripide F G A Avokpaho, Ashish Awasthi, Harish Chander Gugnani, Yuming Guo, Prakash C Gupta, Rahul Gupta,
Beatriz Paulina Ayala Quintanilla, Rakesh Ayer, Peter S Azzopardi, Rajeev Gupta, Tanush Gupta, Bishal Gyawali, Juanita A Haagsma,
Arefeh Babazadeh, Hamid Badali, Alaa Badawi, Ayele Geleto Bali, Vladimir Hachinski, Nima Hafezi-Nejad, Hassan Haghparast Bidgoli,
Katherine E Ballesteros, Shoshana H Ballew, Maciej Banach, Tekleberhan B Hagos, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian,
Joseph Adel Mattar Banoub, Amrit Banstola, Aleksandra Barac, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi,
Miguel A Barboza, Suzanne Lyn Barker-Collo, Alexis J Handal, Graeme J Hankey, Yuantao Hao, Hilda L Harb,
Till Winfried Bärnighausen, Lope H Barrero, Bernhard T Baune, Sivadasanpillai Harikrishnan, Josep Maria Haro, Mehedi Hasan,
Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller,
Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Caitlin N Hawley, Roderick J Hay, Simon I Hay,
Abate Bekele Belachew, Yihalem Abebe Belay, Michelle L Bell, Akbar Hedayatizadeh-Omran, Behzad Heibati, Delia Hendrie,
Aminu K Bello, Isabela M Bensenor, Eduardo Bernabe, Andualem Henok, Claudiu Herteliu, Sousan Heydarpour,
Robert S Bernstein, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Desalegn Tsegaw Hibstu, Huong Thanh Hoang, Hans W Hoek,
Suraj Bhattarai, Soumyadeep Bhaumik, Zulfiqar A Bhutta, Howard J Hoffman, Michael K Hole, Enayatollah Homaie Rad,
Belete Biadgo, Ali Bijani, Boris Bikbov, Ver Bilano, Nigus Bililign, Praveen Hoogar, H Dean Hosgood, Seyed Mostafa Hosseini,
Muhammad Shahdaat Bin Sayeed, Donal Bisanzio, Brigette F Blacker, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Peter J Hotez,
Fiona M Blyth, Ibrahim R Bou-Orm, Soufiane Boufous, Rupert Bourne, Damian G Hoy, Mohamed Hsairi, Aung Soe Htet, Guoqing Hu,
Oliver J Brady, Michael Brainin, Luisa C Brant, Alexandra Brazinova, John J Huang, Chantal K Huynh, Kim Moesgaard Iburg,
Nicholas J K Breitborde, Hermann Brenner, Paul Svitil Briant, Chad Thomas Ikeda, Bogdan Ileanu, Olayinka Stephen Ilesanmi,
Andrew M Briggs, Andrey Nikolaevich Briko, Gabrielle Britton, Usman Iqbal, Seyed Sina Naghibi Irvani, Caleb Mackay Salpeter Irvine,
Traolach Brugha, Rachelle Buchbinder, Reinhard Busse, Zahid A Butt, Sheikh Mohammed Shariful Islam, Farhad Islami, Kathryn H Jacobsen,
Lucero Cahuana-Hurtado, Jorge Cano, Rosario Cárdenas, Juan J Carrero,

Leila Jahangiry, Nader Jahanmehr, Sudhir Kumar Jain, Azin Nahvijou, Gurudatta Naik, Nitish Naik, Farid Najafi, Luigi Naldi,
Mihajlo Jakovljevic, Mehdi Javanbakht, Achala Upendra Jayatilleke, Hae Sung Nam, Vinay Nangia, Jobert Richie Nansseu,
Panniyammakal Jeemon, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Bruno Ramos Nascimento, Gopalakrishnan Natarajan, Nahid Neamati,
Catherine O Johnson, Jost B Jonas, Jacek Jerzy Jozwiak, Ionut Negoi, Ruxandra Irina Negoi, Subas Neupane,
Suresh Banayya Jungari, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Charles Richard James Newton, Josephine W Ngunjiri,
Amaha Kahsay, Rizwan Kalani, Tanuj Kanchan, Manoochehr Karami, Anh Quynh Nguyen, Ha Thu Nguyen, Huong Lan Thi Nguyen,
Behzad Karami Matin, André Karch, Corine Karema, Narges Karimi, Huong Thanh Nguyen, Long Hoang Nguyen, Minh Nguyen,
Seyed M Karimi, Amir Kasaeian, Dessalegn H Kassa, Nam Ba Nguyen, Son Hoang Nguyen, Emma Nichols,
Getachew Mullu Kassa, Tesfaye Dessale Kassa, Nicholas J Kassebaum, Dina Nur Anggraini Ningrum, Molly R Nixon, Nomonde Nolutshungu,
Srinivasa Vittal Katikireddi, Norito Kawakami, Ali Kazemi Karyani, Shuhei Nomura, Ole F Norheim, Mehdi Noroozi, Bo Norrving,
Masoud Masoud Keighobadi, Peter Njenga Keiyoro, Laura Kemmer, Jean Jacques Noubiap, Hamid Reza Nouri,
Grant Rodgers Kemp, Andre Pascal Kengne, Andre Keren, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi,
Yousef Saleh Khader, Behzad Khafaei, Morteza Abdullatif Khafaie, Elaine O Nsoesie, Peter S Nyasulu, Christopher M Odell,
Alireza Khajavi, Ibrahim A Khalil, Ejaz Ahmad Khan, Richard Ofori-Asenso, Felix Akpojene Ogbo, In-Hwan Oh,
Muhammad Shahzeb Khan, Muhammad Ali Khan, Young-Ho Khang, Olanrewaju Oladimeji, Andrew T Olagunju, Tinuke O Olagunju,
Mohammad Khazaei, Abdullah T Khoja, Ardeshir Khosravi, Pedro R Olivares, Helen Elizabeth Olsen,
Mohammad Hossein Khosravi, Aliasghar A Kiadaliri, Daniel N Kiirithio, Bolajoko Olubukunola Olusanya, Kanyin L Ong, Sok King Ong,
Cho-Il Kim, Daniel Kim, Pauline Kim, Young-Eun Kim, Yun Jin Kim, Eyal Oren, Alberto Ortiz, Erika Ota, Stanislav S Otstavnov,
Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Simon Øverland, Mayowa Ojo Owolabi, Mahesh P A, Rosana Pacella,
Katarzyna Kissimova-Skarbek, Mika Kivimäki, Amir H Pakpour, Adrian Pana, Songhomitra Panda-Jonas, Andrea Parisi,
Ann Kristin Skrindo Knudsen, Jonathan M Kocarnik, Sonali Kochhar, Eun-Kee Park, Charles D H Parry, Shanti Patel, Sanghamitra Pati,
Yoshihiro Kokubo, Tufa Kolola, Jacek A Kopec, Soewarta Kosen, Snehal T Patil, Ajay Patle, George C Patton, Vishnupriya Rao Paturi,
Georgios A Kotsakis, Parvaiz A Koul, Ai Koyanagi, Katherine R Paulson, Neil Pearce, David M Pereira, Norberto Perico,
Michael A Kravchenko, Kewal Krishan, Kristopher J Krohn, Konrad Pesudovs, Hai Quang Pham, Michael R Phillips, David M Pigott,
Barthelemy Kuate Defo, Burcu Kucuk Bicer, G Anil Kumar, Julian David Pillay, Michael A Piradov, Meghdad Pirsaheb,
Manasi Kumar, Hmwe Hmwe Kyu, Deepesh P Lad, Sheetal D Lad, Farhad Pishgar, Oleguer Plana-Ripoll, Dietrich Plass, Suzanne Polinder,
Alessandra Lafranconi, Ratilal Lalloo, Tea Lallukka, Faris Hasan Lami, Svetlana Popova, Maarten J Postma, Akram Pourshams,
Van C Lansingh, Arman Latifi, Kathryn Mei-Ming Lau, Jeffrey V Lazarus, Hossein Poustchi, Dorairaj Prabhakaran, Swayam Prakash, V Prakash,
Janet L Leasher, Jorge R Ledesma, Paul H Lee, James Leigh, Caroline A Purcell, Manorama B Purwar, Mostafa Qorbani,
Janni Leung, Miriam Levi, Sonia Lewycka, Shanshan Li, Yichong Li, D Alex Quistberg, Amir Radfar, Anwar Rafay, Alireza Rafiei,
Yu Liao, Misgan Legesse Liben, Lee-Ling Lim, Stephen S Lim, Fakher Rahim, Kazem Rahimi, Afarin Rahimi-Movaghar,
Shiwei Liu, Rakesh Lodha, Katharine J Looker, Alan D Lopez, Vafa Rahimi-Movaghar, Mahfuzar Rahman,
Stefan Lorkowski, Paulo A Lotufo, Nicola Low, Rafael Lozano, Mohammad Hifz ur Rahman, Muhammad Aziz Rahman,
Tim C D Lucas, Lydia R Lucchesi, Raimundas Lunevicius, Sajjad Ur Rahman, Rajesh Kumar Rai, Fatemeh Rajati, Usha Ram,
Ronan A Lyons, Stefan Ma, Erlyn Rachelle King Macarayan, Prabhat Ranjan, Anna Ranta, Puja C Rao, David Laith Rawaf,
Mark T Mackay, Fabiana Madotto, Hassan Magdy Abd El Razek, Salman Rawaf, K Srinath Reddy, Robert C Reiner, Nickolas Reinig,
Muhammed Magdy Abd El Razek, Dhaval P Maghavani, Marissa Bettay Reitsma, Giuseppe Remuzzi, Andre M N Renzaho,
Narayan Bahadur Mahotra, Hue Thi Mai, Marek Majdan, Serge Resnikoff, Satar Rezaei, Mohammad Sadegh Rezai,
Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Antonio Luiz P Ribeiro, Nicholas L S Roberts, Stephen R Robinson,
Deborah Carvalho Malta, Abdullah A Mamun, Ana-Laura Manda, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Ali Rostami,
Helena Manguerra, Treh Manhertz, Mohammad Ali Mansournia, Gregory A Roth, Ambuj Roy, Enrico Rubagotti, Perminder S Sachdev,
Lorenzo Giovanni Mantovani, Chabila Christopher Mapoma, Nafis Sadat, Basema Saddik, Ehsan Sadeghi, Sahar Saeedi Moghaddam,
Joemer C Maravilla, Wagner Marcenes, Ashley Marks, Hosein Safari, Yahya Safari, Roya Safari-Faramani, Mahdi Safdarian,
Francisco Rogerlândio Martins-Melo, Ira Martopullo, Winfried März, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar,
Melvin B Marzan, Tivani Phosa Mashamba-Thompson, Mohammad Ali Sahraian, Haniye Sadat Sajadi, Nasir Salam,
Benjamin Ballard Massenburg, Manu Raj Mathur, Kunihiro Matsushita, Joseph S Salama, Payman Salamati, Komal Saleem, Zikria Saleem,
Pallab K Maulik, Mohsen Mazidi, Colm McAlinden, John J McGrath, Yahya Salimi, Joshua A Salomon, Sundeep Santosh Salvi, Inbal Salz,
Martin McKee, Man Mohan Mehndiratta, Ravi Mehrotra, Kala M Mehta, Abdallah M Samy, Juan Sanabria, Yingying Sang,
Varshil Mehta, Fabiola Mejia-Rodriguez, Tesfa Mekonen, Addisu Melese, Damian Francesco Santomauro, Itamar S Santos, João Vasco Santos,
Mulugeta Melku, Michele Meltzer, Peter T N Memiah, Ziad A Memish, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Mayank Sardana,
Walter Mendoza, Desalegn Tadese Mengistu, Getnet Mengistu, Abdur Razzaque Sarker, Nizal Sarrafzadegan, Benn Sartorius,
George A Mensah, Seid Tiku Mereta, Atte Meretoja, Tuomo J Meretoja, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy,
Tomislav Mestrovic, Naser Mohammad Gholi Mezerji, Arundhati R Sawant, Monika Sawhney, Sonia Saxena, Mete Saylan,
Bartosz Miazgowski, Tomasz Miazgowski, Anoushka I Millear, Elke Schaeffner, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker,
Ted R Miller, Benjamin Miltz, G K Mini, Mojde Mirarefin, David C Schwebel, Falk Schwendicke, James G Scott, Mario Sekerija,
Erkin M Mirrakhimov, Awoke Temesgen Misganaw, Philip B Mitchell, Sadaf G Sepanlou, Edson Serván-Mori, Seyedmojtaba Seyedmousavi,
Habtamu Mitiku, Babak Moazen, Bahram Mohajer, Hosein Shabaninejad, Azadeh Shafieesabet, Mehdi Shahbazi,
Karzan Abdulmuhsin Mohammad, Noushin Mohammadifard, Amira A Shaheen, Masood Ali Shaikh, Mehran Shams-Beyranvand,
Mousa Mohammadnia-Afrouzi, Mohammed A Mohammed, Mohammadbagher Shamsi, Morteza Shamsizadeh, Heidar Sharafi,
Shafiu Mohammed, Farnam Mohebi, Modhurima Moitra, Kiomars Sharafi, Mehdi Sharif, Mahdi Sharif-Alhoseini,
Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Yoshan Moodley, Meenakshi Sharma, Rajesh Sharma, Jun She, Aziz Sheikh, Peilin Shi,
Mahmood Moosazadeh, Ghobad Moradi, Maziar Moradi-Lakeh, Kenji Shibuya, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi,
Mehdi Moradinazar, Paula Moraga, Lidia Morawska, Kawkab Shishani, Ivy Shiue, Farhad Shokraneh, Haitham Shoman,
Ilais Moreno Velásquez, Joana Morgado-Da-Costa, Mark G Shrime, Si Si, Soraya Siabani, Tariq J Siddiqi,
Shane Douglas Morrison, Marilita M Moschos, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, João Pedro Silva,
W Cliff Mountjoy-Venning, Seyyed Meysam Mousavi, Dayane Gabriele Alves Silveira, Narayana Sarma Venkata Singam,
Kalayu Brhane Mruts, Achenef Asmamaw Muche, Jasvinder A Singh, Narinder Pal Singh, Virendra Singh,
Kindie Fentahun Muchie, Ulrich Otto Mueller, Oumer Sada Muhammed, Dhirendra Narain Sinha, Eirini Skiadaresi, Erica Leigh N Slepak,
Satinath Mukhopadhyay, Kate Muller, John Everett Mumford, Karen Sliwa, David L Smith, Mari Smith, Adauto Martins Soares Filho,
Manoj Murhekar, Jonah Musa, Kamarul Imran Musa, Ghulam Mustafa, Badr Hasan Sobaih, Soheila Sobhani, Eugène Sobngwi, Samir S Soneji,
Ashraf F Nabhan, Chie Nagata, Mohsen Naghavi, Aliya Naheed, Moslem Soofi, Masoud Soosaraei, Reed J D Sorensen, Joan B Soriano,

Ireneous N Soyiri, Luciano A Sposato, Department of Health Metrics Sciences (A Afshin MD,
Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Jeffrey D Stanaway, E A Cromwell PhD, C El Bcheraoui PhD, Prof S I Hay FMedSci,
Dan J Stein, Caitlyn Steiner, Timothy J Steiner, Mark A Stokes, I A Khalil MD, H H Kyu PhD, Prof S S Lim PhD, Prof R Lozano MD,
Lars Jacob Stovner, Michelle L Subart, Agus Sudaryanto, A T Misganaw PhD, Prof A H Mokdad PhD, Prof M Naghavi MD,
Mu’awiyyah Babale Sufiyan, Bruno F Sunguya, Patrick John Sur, D M Pigott DPhil, R C Reiner PhD, N L S Roberts BS,
Ipsita Sutradhar, Bryan L Sykes, Dillon O Sylte, Prof D L Smith PhD, J D Stanaway PhD, Prof S E Vollset DrPH,
Rafael Tabarés-Seisdedos, Santosh Kumar Tadakamadla, Prof T Vos PhD, Prof C J L Murray DPhil), Department of Global Health
Birkneh Tilahun Tadesse, Nikhil Tandon, Segen Gebremeskel Tassew, (F J Charlson PhD, S Kochhar MD, R J D Sorensen MPH), Division of
Mohammad Tavakkoli, Nuno Taveira, Hugh R Taylor, Hematology (C Fitzmaurice MD), Department of Otolaryngology-Head
Arash Tehrani-Banihashemi, Tigist Gashaw Tekalign, and Neck Surgery (N D Futran MD), Department of Neurology
Shishay Wahdey Tekelemedhin, Merhawi Gebremedhin Tekle, (R Kalani MD), Department of Periodontics (G A Kotsakis DDS),
Habtamu Temesgen, Mohamad-Hani Temsah, Omar Temsah, Division of Plastic Surgery (B B Massenburg MD), Department of
Abdullah Sulieman Terkawi, Mebrahtu Teweldemedhin, Surgery (S D Morrison MD), Department of Bioinformatics and Medical
Kavumpurathu Raman Thankappan, Nihal Thomas, Binyam Tilahun, Education (E O Nsoesie PhD), Division of Cardiology, Department of
Quyen G To, Marcello Tonelli, Roman Topor-Madry, Fotis Topouzis, Medicine (G A Roth MD), Department of Psychiatry and Behavioral
Anna E Torre, Miguel Tortajada-Girbés, Mathilde Touvier, Sciences (Prof J Unutzer MD), Department of Medicine (T E West MD),
Marcos Roberto Tovani-Palone, Jeffrey A Towbin, Bach Xuan Tran, University of Washington, Seattle, WA, USA (Prof E Oren PhD); School
Khanh Bao Tran, Christopher E Troeger, Thomas Clement Truelsen, of Pharmacy (J Abdela MSc, G Mengistu MSc), Department of Medical
Miltiadis K Tsilimbaris, Derrick Tsoi, Lorainne Tudor Car, Laboratory Science (Z Ataro MSc, F Weldegebreal MPH, H Mitiku MSc),
E Murat Tuzcu, Kingsley N Ukwaja, Irfan Ullah, Eduardo A Undurraga, School of Public Health (A G Bali MPH, M G Tekle MPH), School of
Jurgen Unutzer, Rachel L Updike, Muhammad Shariq Usman, Nursing and Midwifery (T T Dasa MSc), Haramaya University, Harar,
Olalekan A Uthman, Muthiah Vaduganathan, Afsane Vaezi, Ethiopia (D Abate MSc, T F Gelano MSc, H Mitiku MSc,
Pascual R Valdez, Santosh Varughese, Tommi Juhani Vasankari, T G Tekalign MS); Department of Population and Family Health
Narayanaswamy Venketasubramanian, Santos Villafaina, (K H Abate PhD, A T Gebremedhin MPH), Department of Epidemiology
Francesco S Violante, Sergey Konstantinovitch Vladimirov, (M B Ahmed MPH), Mycobacteriology Research Center (E Duken MSc),
Vasily Vlassov, Stein Emil Vollset, Kia Vosoughi, Isidora S Vujcic, Department of Health Education & Behavioral Sciences
Fasil Shiferaw Wagnew, Yasir Waheed, Stephen G Waller, Yafeng Wang, (G T Feyissa MPH), Department of Environmental Health Sciences and
Yuan-Pang Wang, Elisabete Weiderpass, Robert G Weintraub, Technology (S Mereta PhD), Jimma University, Jimma, Ethiopia;
Daniel J Weiss, Fitsum Weldegebreal, Kidu Gidey Weldegwergs, Department of Pharmacology and Clinical Pharmacy (S M Abay PhD,
Andrea Werdecker, T Eoin West, Harvey A Whiteford, Justyna Widecka, O S Muhammed MSc), School of Public Health (Prof G Davey MD,
Tissa Wijeratne, Lauren B Wilner, Shadrach Wilson, K Deribe PhD), School of Allied Health Sciences (E Yisma MPH), Addis
Andrea Sylvia Winkler, Alison B Wiyeh, Charles Shey Wiysonge, Ababa University, Addis Ababa, Ethiopia (G T Demoz MSc); Department
Charles D A Wolfe, Anthony D Woolf, Shouling Wu, Yun-Chun Wu, of Law Philosophy and Economic Studies, La Sapienza University,
Grant M A Wyper, Denis Xavier, Gelin Xu, Simon Yadgir, Rome, Italy (C Abbafati PhD); Non-Communicable Diseases Research
Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Center (N Abbasi MD, F Farzadfar MD, S N Irvani MD,
Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Yasin Jemal Yasin, S Saeedi Moghaddam MSc, M Shams-Beyranvand MSc,
Alex Yeshaneh, Ebrahim M Yimer, Paul Yip, Engida Yisma, H Ebrahimi MD, B Mohajer MD, F Mohebi MD, F Pishgar MD),
Naohiro Yonemoto, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Department of Health (H Abbastabar PhD), Endocrinology and
Mahmoud Yousefifard, Chuanhua Yu, Vesna Zadnik, Zoubida Zaidi, Metabolism Research Center (M Afarideh MD, Prof A Esteghamati MD,
Sojib Bin Zaman, Mohammad Zamani, Zohreh Zare, M Ganji MD), Department of Health Management and Economics
Ayalew Jejaw Zeleke, Zerihun Menlkalew Zenebe, Kai Zhang, (M Anjomshoa PhD, S Mousavi PhD), Liver and Pancreaticobilliary
Zheng Zhao, Maigeng Zhou, Sanjay Zodpey, Inbar Zucker, Theo Vos, Disease Research Center (H Ebrahimi MD), Multiple Sclerosis Research
and Christopher J L Murray. Center (S Eskandarieh PhD, B Mohajer MD, Prof M Sahraian MD),
Endocrine Research Center (S Esteghamati MD), School of Medicine
Affiliations
(N Hafezi-Nejad MD), Department of Pharmacology
Institute for Health Metrics and Evaluation (S L James MD,
(A Haj-Mirzaian MD), Department of Epidemiology and Biostatistics
A Afshin MD, K M Agesa BA, T Alam MPH, K E Ballesteros PhD,
(Prof S Hosseini PhD, M Mansournia PhD, M Yaseri PhD), Hematologic
B F Blacker MPH, P S Briant BS, A Carter MPH, K M Cercy BS,
Malignancies Research Center (A Kasaeian PhD), Knowledge Utilization
E A Cromwell PhD, Prof L Dandona MD, Prof R Dandona PhD,
Research Center (Prof R Majdzadeh PhD), Digestive Diseases Research
Prof L Degenhardt PhD, S Deiparine BA, S D Dharmaratne MD,
Institute (Prof R Malekzadeh MD, Prof A Pourshams MD,
M A Dirac MD, M M Echko BSc, C El Bcheraoui PhD,
H Poustchi PhD, G Roshandel PhD, S G Sepanlou MD), Iran National
Prof V L Feigin PhD, C Fitzmaurice MD, K J Foreman PhD,
Institute of Health Research (F Mohebi MD, H S Sajadi PhD), Cancer
T D Frank BS, N Fullman MPH, W M Gardner AB, E M Goldberg MPH,
Research Center (A Nahvijou PhD, R Shirkoohi PhD), Uro-Oncology
T M Gorman BS, C N Hawley MSPH, Prof S I Hay FMedSci,
Research Center (M Nowroozi MD, F Pishgar MD), Iranian National
C K Huynh BA, C T Ikeda BS, C M S Irvine BS, C O Johnson PhD,
Center for Addiction Studies (Prof A Rahimi-Movaghar MD), Sina
N J Kassebaum MD, L Kemmer PhD, G R Kemp BA, I A Khalil MD,
Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD,
P Kim BA, J M Kocarnik PhD, K J Krohn MPH, H H Kyu PhD,
M Safdarian MD, Prof P Salamati MD, M Sharif-Alhoseini PhD), Center
K M Lau BS, J R Ledesma BA, Prof S S Lim PhD, Prof A D Lopez PhD,
of Expertise in Microbiology (Prof S Seyedmousavi PhD), Cancer Biology
Prof R Lozano MD, L R Lucchesi BA, H Manguerra BS, T Manhertz BA,
Research Center (R Shirkoohi PhD), Department of Anatomy
A Marks MA, I Martopullo MPH, A I Millear MPH, B Miltz MS,
(S Sobhani MD), Hematology-Oncology and Stem Cell Transplantation
A T Misganaw PhD, M Moitra MPH, Prof A H Mokdad PhD,
Research Center (A Kasaeian PhD), Community-Based
W C Mountjoy-Venning BA, K Muller MPH, J E Mumford BA,
Participatory-Research Center (Prof R Majdzadeh PhD), Tehran
Prof M Naghavi MD, M Nguyen BS, E Nichols BA, M R Nixon PhD,
University of Medical Sciences, Tehran, Iran; Montreal Neuroimaging
E O Nsoesie PhD, C M Odell MPP, H E Olsen MA, K L Ong PhD,
Center (N Abbasi MD), Montreal Neurological Institute
K R Paulson BS, D M Pigott DPhil, C A Purcell BA, P C Rao MPH,
(S Fereshtehnejad PhD), McGill University, Montreal, QC, Canada;
R C Reiner PhD, N Reinig BS, M B Reitsma BS, N Sadat MA,
Department of Neurology, Cairo University, Cairo, Egypt
J S Salama MSc, E N Slepak MLIS, Prof D L Smith PhD, M Smith MPA,
(Prof F Abd-Allah MD, Prof A Abdelalim MD); Department of
R J D Sorensen MPH, V Srinivasan BA, J D Stanaway PhD,
Epidemiology, Arak University of Medical Sciences, Arak, Iran
C Steiner MPH, M L Subart BA, P J Sur MPH, D O Sylte BA,
(I Abdollahpour PhD); Multiple Sclerosis Research Center, Tehran, Iran
A E Torre BS, C E Troeger MPH, D Tsoi BS, R L Updike BA,
(I Abdollahpour PhD); Department of Statistics, Manonmaniam
Prof S E Vollset DrPH, Prof H A Whiteford PhD, L B Wilner MPH,
Sundaranar University, Tirunelveli, India (R S Abdulkader MD); Human
S Wilson BS, S Yadgir BS, Prof T Vos PhD, Prof C J L Murray DPhil),

Nutrition Department (Z Abebe MSc), Institute of Public Health M Soofi PhD), Department of Food Technology & Quality Control
(K A Alene MPH, A F Dadi MPH, M Melku MSc, A A Muche MPH, (E Sadeghi PhD), Sports Medicine & Rehabilitation (M Shamsi PhD),
K Muchie MSc, B Tilahun PhD), Department of Clinical Chemistry Imam Ali Cardiovascular Research Center (S Siabani PhD), Kermanshah
(B Biadgo MSc), Department of Medical Parasitology (A J Zeleke MSc), University of Medical Sciences, Kermanshah, Iran (K Ghadiri BEP,
University of Gondar, Gondar, Ethiopia; School of Public Health S Heydarpour PhD, Prof M Pirsaheb PhD, Y Safari PhD,
(S F Abera MSc, A B Belachew MSc), Clinical Pharmacy Unit K Sharafi PhD); Environmental Technologies Research Center
(H N Abraha MSc, T D Kassa MSc, K G Weldegwergs MSc), Department (M Ahmadi PhD), Department of Public Health (M A Khafaie PhD),
of Nutrition and Dietetics (M G Degefa BSc, A Kahsay MPH), School of Thalassemia and Hemoglobinopathy Research Center (F Rahim PhD),
Pharmacy (A K Gebre MSc, T G Gebremichael MSc, E M Yimer MSc), Department of Neurosurgery (H Safari MD), Medical Physics
Department of Biostatistics (K Gezae MSc), Anatomy Unit Department (A Yadollahpour PhD), Ahvaz Jundishapur University of
(T B Hagos MSc), Biomedical Sciences Division (G B Hailu MSc), Medical Sciences, Ahvaz, Iran; Department of Ophthalmology
School of Medicine (D T Mengistu MSc), Department of Environmental (H Ahmadieh MD), Research Institute for Endocrine Sciences
Health and Behavioral Sciences (Y J Yasin MSc), Department of (A Haj-Mirzaian MD, S N Irvani MD), Safety Promotion and Injury
Midwifery (Z M Zenebe MSc), Mekelle University, Mekelle, Ethiopia Prevention Research Center (N Jahanmehr PhD), Department of
(S G Tassew MSc, S W Tekelemedhin MPH); Institute of Biological Biostatistics (A Khajavi MSc), Ophthalmic Research Center (S Safi PhD,
Chemistry and Nutrition, University of Hohenheim, Stuttgart, Germany M Yaseri PhD, H Ahmadieh MD), School of Public Health
(S F Abera MSc); Department of Medical Laboratory Sciences (N Jahanmehr PhD), Ophthalmic Epidemiology Research Center
(O Abil MSc), Department of Health Sciences (E Duken MSc), Wollega (S Safi PhD), Shahid Beheshti University of Medical Sciences, Tehran,
University, Nekemte, Ethiopia; School of Public Health, University of Iran (V Fallah Omrani PhD); University Ferhat Abbas of Setif, Algeria
Medical Science, Ondo, Ondo, Nigeria (O Abil MSc); Department of (A Aichour BMedSc, I Aichour Bpharm); Higher National School of
Healthcare Policy and Research, Weill Cornell Medical College in Qatar, Veterinary Medicine, Algiers, Algeria (M Aichour MA); Department of
Doha, Qatar (Prof L J Abu-Raddad PhD); Institute of Community and Epidemiology, University of Kentucky, Lexington, KY, USA
Public Health, Birzeit University, Birzeit, Palestine (T Akinyemiju PhD); The Hospital for Sick Children (N Akseer PhD),
(N M E Abu-Rmeileh PhD); Bénin Clinical Research Institute (IRCB), Department of Nutritional Sciences (A Badawi PhD), The Centre for
Cotonou, Benin (M M K Accrombessi PhD, E F A Avokpaho MD); Global Child Health, Hospital for Sick Children (Prof Z A Bhutta PhD),
Department of Preventive Medicine, Dongguk University, Gyeongju, Dalla Lana School of Public Health (S Popova PhD), University of
South Korea (D Acharya MPH); Department of Community Medicine, Toronto, Toronto, ON, Canada; Internal Medicine Department,
Kathmandu University, Devdaha, Nepal (D Acharya MPH); Department Washington University in St Louis, St Louis, MO, USA (Z Al-Aly MD);
of Non-Communicable Diseases (B Gyawali MPH), Nepal Development Clinical Epidemiology Center, VA St Louis Health Care System,
Society, Pokhara, Nepal (P Acharya MPH); School of Public Health and Department of Veterans Affairs, St Louis, MO, USA (Z Al-Aly MD);
Preventive Medicine (I N Ackerman PhD, Prof F M Cicuttini PhD, Pediatric Intensive Care Unit (A Al-Eyadhy MD), Department of
Prof Y Guo PhD, S Li PhD, S Si PhD), Department of Epidemiology and Pediatrics (B H Sobaih MD, M Temsah MRCPCH), King Saud
Preventive Medicine (Prof R Buchbinder PhD, K L Chin PhD), Monash University, Riyadh, Saudi Arabia (K Altirkawi MD); Medical Research
Centre for Health Research and Implementation (B De Courten PhD), Center (H M Al-Mekhlafi PhD), Jazan University, Jazan, Saudi Arabia
Department of Medicine (S Gall PhD), Centre of Cardiovascular (Prof N Bedi MD); Department of Medical Parasitology, Sana’a
Research and Education in Therapeutics (R Ofori-Asenso MSc), Monash University, Sana’a, Yemen (H M Al-Mekhlafi PhD); Department of
University, Melbourne, VIC, Australia; Department of Global Health Family and Community Medicine, King Abdulaziz University, Jeddah,
(A A Adamu MSc, O O Adetokunboh MD, Prof C S Wiysonge MD), Saudi Arabia (Prof R M Al-Raddadi PhD); Evidence Based Practice
Faculty of Medicine & Health Sciences (Prof P S Nyasulu PhD), Center, Mayo Clinic Foundation for Medical Education and Research,
Department of Psychiatry (Prof C D H Parry PhD), Stellenbosch Rochester, MN, USA (F Alahdab MD); School of Population and Global
University, Cape Town, South Africa; Cochrane South Africa Health (K Alam PhD), School of Medicine (Prof G J Hankey MD),
(A A Adamu MSc, O O Adetokunboh MD), South African Medical University of Western Australia, Perth, WA, Australia; Cardiovascular
Research Council, Cape Town, South Africa (Prof D J Stein MD); Medicine (A Alashi MD, Prof E Tuzcu MD), Cleveland Clinic, Cleveland,
Department of Medicine, University College Hospital, Ibadan, Ibadan, OH, USA; Baqiyatallah Research Center for Gastroenterology and Liver
Nigeria (O M Adebayo MD); School of Medicine, Cardiff University, Diseases (Prof S Alavian MD), Student Research Committee
Cardiff, UK (V Adekanmbi PhD); Emergency Department, Saint Mark (M Khosravi MD), Baqiyatallah University of Medical Sciences, Tehran,
Hospital, Alexandria, Egypt (M G Adib MD); Sport Science Department Iran; Research School of Population Health (K A Alene MPH), National
(J C Adsuar PhD, S Villafaina MSc), University of Extremadura, Badajoz, Centre for Epidemiology and Population Health (M Bin Sayeed MSPS,
Spain (D Collado-Mateo MSc); Department of Public Health, University A Parisi MD), Australian National University, Canberra, ACT, Australia;
of Lomé, Lomé, Togo (K A Afanvi MD); Prefectoral Direction of the Department of Public Health (Prof A H Pakpour PhD), Qazvin
Health of the Zio, Ministry of Health and Social Protection, Tsevie, Togo University of Medical Sciences, Qazvin, Iran (M Alijanzadeh PhD);
(K A Afanvi MD); Department of Family Medicine (G Agarwal MD), Gastrointestinal Cancer Research Center (R Alizadeh-Navaei PhD),
Department of Pathology and Molecular Medicine (T O Olagunju MD), Department of Medical Mycology (H Badali PhD), Toxoplasmosis
McMaster University, Hamilton, ON, Canada; Department of Research Center (Prof A Daryani PhD, S Sarvi PhD), School of Public
Gastroenterology (Prof R Aggarwal MD), Department of Nephrology Health (Prof A Enayati PhD), Department of Neurology (N Karimi MD),
(S Prakash PhD), Sanjay Gandhi Postgraduate Institute of Medical Health Sciences Research Center (M Moosazadeh PhD), Molecular and
Sciences, Lucknow, India; Department of Zoology, Yerevan State Cell Biology Research Center (Prof A Rafiei PhD), Department of
University, Yerevan, Armenia (S A Aghayan PhD); Research Group of Pediatrics (M Rezai MD), Invasive Fungi Research Center
Molecular Parasitology, Scientific Center of Zoology and Hydroecology, (Prof S Seyedmousavi PhD), Department of Medical Mycology and
Yerevan, Armenia (S A Aghayan PhD); Indian Institute of Public Health Parasitology (A Vaezi PhD), Immunogenetics Research Center
(Prof S Zodpey PhD), Public Health Foundation of India, Gurugram, (N Karimi MD), Pharmaceutical Sciences Research Center
India (S Agrawal PhD, A Awasthi PhD, Prof L Dandona MD, (M M Keighobadi PhD), Department of Immunology
Prof R Dandona PhD, G A Kumar PhD, M R Mathur PhD, (Prof A Rafiei PhD), Mazandaran University of Medical Sciences, Sari,
Prof D Prabhakaran DM, K S Reddy DM); Vital Strategies, Gurugram, Iran (A Hedayatizadeh-Omran PhD, M M Keighobadi PhD,
India (S Agrawal PhD); Department of Anesthesiology (A Ahmadi PhD), M Nourollahpour Shiadeh PhD, Z Zare PhD); Department of Health
Faculty of Public Health (B Karami Matin PhD, A Kazemi Karyani PhD, Policy and Management, Kuwait University, Safat, Kuwait
R Safari-Faramani PhD), Research Center for Environmental (Prof S M Aljunid PhD); International Centre for Casemix and Clinical
Determinants of Health (M Moradinazar PhD), Department of Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
Epidemiology & Biostatistics (Prof F Najafi PhD, Y Salimi PhD), (Prof S M Aljunid PhD); Department of Population Health, Luxembourg
Department of Health Education & Promotion (F Rajati PhD), Institute of Health, Strassen, Luxembourg (A Alkerwi PhD); University
Environmental Determinants of Health Research Center (S Rezaei PhD, of Bordeaux, Bordeaux, France (Prof F Alla PhD); Department of Public

Health Sciences (Prof P Allebeck MD, Z El-Khatib PhD), Department of Local Health District, Sydney, NSW, Australia (A Arora PhD);
Neurobiology (Prof J Ärnlöv PhD), Department of Medical Epidemiology Department of Community Health Sciences, University of Manitoba,
and Biostatistics (J J Carrero PhD, Prof E Weiderpass PhD), Department Winnipeg, MB, Canada (A Artaman PhD); Monitoring Evaluation and
of Neurobiology, Care Sciences and Society (S Fereshtehnejad PhD), Operational Research Project, Abt Associates Nepal, Lalitpur, Nepal
Karolinska Institutet, Stockholm, Sweden; Swedish Research Council for (K K Aryal PhD); Qom University of Medical Sciences, Qom, Iran
Health, Working Life, and Welfare, Stockholm, Sweden (H Asayesh MSc); South Asian Public Health Forum, Lahore, Pakistan
(Prof P Allebeck MD); Department of Medicine, University of Setif (R J Asghar MPH); Center for Clinical Global Health Education
Algeria, Sétif, Algeria (Prof M M L Alouani PhD); Research Group on (S R Atre PhD), Department of Epidemiology (S H Ballew PhD),
Health Economics, University of Cartagena, Cartagena, Colombia Bloomberg School of Public Health (J Coresh PhD), School of Medicine
(Prof N Alvis-Guzman PhD); Research Group in Hospital Management (M E Grams PhD), Division of Cardiovascular and Clinical Epidemiology
and Health Policies, University of the Coast, Barranquilla, Colombia (M E Grams PhD), Department of Radiology (N Hafezi-Nejad MD,
(Prof N Alvis-Guzman PhD); Sansom Institute (A Amare PhD), A Haj-Mirzaian MD, Prof K Matsushita MD), Department of Health
Wardliparingga Aboriginal Research Unit (P S Azzopardi PhD), Policy and Management (A T Khoja MD), Epidemiology (Y Sang MSc),
South Australian Health and Medical Research Institute, Adelaide, SA, Department of Gastrointestinal and Hepatology (K Vosoughi MD),
Australia; Department of Public Health Nutrition (N Fentahun PhD), Johns Hopkins University, Baltimore, MD, USA; Dr D Y Patil Medical
Department of Psychiatry (T Mekonen MSc), Bahir Dar University, Bahir College (S R Atre PhD), Dr D Y Patil Vidyapeeth, Pune, India
Dar, Ethiopia (A Amare PhD); School of Public Health (L N Aminde MD, (A R Sawant MD); School of Business (Prof M Ausloos PhD),
F J Charlson PhD, H E Erskine PhD, A J Ferrari PhD, Department of Health Sciences (Prof T Brugha MD), University of
D F Santomauro PhD, J G Scott PhD), School of Dentistry Leicester, Leicester, UK; Center for Health Systems Research
(R Lalloo PhD), Institute for Social Science Research (A A Mamun PhD, (L Avila-Burgos PhD, L Cahuana-Hurtado PhD, H Gómez-Dantés MSc,
J C Maravilla PhD), Queensland Brain Institute (Prof J J McGrath MD), Prof E Serván-Mori DSc), Centro de Investigacion en Nutricion y Salud
The University of Queensland, Brisbane, QLD, Australia (J Leung PhD, (F Mejia-Rodriguez MSc), National Institute of Public Health,
Prof H A Whiteford PhD); Department of the Health Industrial Complex Cuernavaca, Mexico; Contrôle Des Maladies Infectieuses
and Innovation in Health (Prof D A Silveira MD), Department of (E F A Avokpaho MD), Non Communicable Disease Department
Diseases and Noncommunicable Diseases and Health Promotion (F G Gankpe MD), Laboratory of Studies and Research-Action in Health,
(A M Soares Filho DSc), Federal Ministry of Health, Beirut, Lebanon Porto Novo, Benin; Indian Institute of Public Health, Gandhinagar,
(Prof W Ammar PhD); Faculty of Health Sciences, American University India (A Awasthi PhD); The Judith Lumley Centre
of Beirut, Beirut, Lebanon (Prof W Ammar PhD); Department of (B Ayala Quintanilla PhD), School of Nursing and Midwifery
Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Prof D Edvardsson PhD), Austin Clinical School of Nursing
(Y A Amoako MD); Faculty of Medicine (N H Anber PhD), Department (M Rahman PhD), Department of Psychology and Counselling
of Clinical Pathology (Prof M El Sayed Zaki PhD), Mansoura University, (Prof T Wijeratne MD), La Trobe University, Melbourne, VIC, Australia;
Mansoura, Egypt (N H Anber PhD); Emergency Hospital of Bucharest General Office for Research and Technological Transfer, Peruvian
(Prof M Beuran PhD, I Negoi PhD), Department of General Surgery National Institute of Health, Lima, Peru (B Ayala Quintanilla PhD);
(D V Davitoiu PhD, M Hostiuc PhD), Department of Legal Medicine and Department of Community and Global Health (R Ayer MHSc),
Bioethics (S Hostiuc PhD), Anatomy and Embryology Department Department of Mental Health (Prof N Kawakami PhD), Department of
(R I Negoi PhD), Carol Davila University of Medicine and Pharmacy, Global Health Policy (S Nomura MSc, Prof K Shibuya MD), Department
Bucharest, Romania (C Andrei PhD); Department of Medicine, of Diabetes and Metabolic Diseases (T Yamada MD), University of
University of Thessaly, Volos, Greece (S Androudi PhD); Department of Tokyo, Tokyo, Japan; Global Adolescent Health Group, Burnet Institute,
Public Health (Y C D Geramo MSc), Arba Minch University, Arba Melbourne, VIC, Australia (P S Azzopardi PhD); Center for Infectious
Minch, Ethiopia (M D Animut MPH); Social Determinants of Health Diseases Research, Babol, Iran (A Babazadeh MD, S Ebrahimpour PhD);
Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Public Health Risk Sciences Division, Public Health Agency of Canada,
Iran (M Anjomshoa PhD, L Jahangiry PhD); Department of Public Toronto, ON, Canada (A Badawi PhD); Department of Hypertension,
Health (M G Ansha MPH, T Kolola MPH, K B Mruts MPH), Medical University of Lodz, Lodz, Poland (Prof M Banach PhD); Polish
Department of Midwifery (M T Dinberu MA), Debre Berhan University, Mothers’ Memorial Hospital Research Institute, Lodz, Poland
Debre Berhan, Ethiopia; Department of Health Policy and (Prof M Banach PhD); Faculty of Medicine, Alexandria University,
Administration (C T Antonio MD), Development and Communication Alexandria, Egypt (J A M Banoub MD); Department of Research, Public
Studies (E K Macarayan PhD), University of the Philippines Manila, Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
Manila, Philippines; Department of Applied Social Sciences (A Banstola MPH); Clinic for Infectious and Tropical Diseases, Clinical
(C T Antonio MD), School of Nursing (P H Lee PhD), Hong Kong Center of Serbia, Belgrade, Serbia (A Barac PhD); Faculty of Medicine
Polytechnic University, Hong Kong, China; Independent Consultant, (A Barac PhD, E Dubljanin PhD), Centre School of Public Health and
Kabul, Afghanistan (P Anwari MSc); Health Management and Health Management (Prof M M Santric Milicevic PhD), Faculty of
Economics Research Center (J Arabloo PhD, M Behzadifar PhD), Medicine Institute of Epidemiology (I S Vujcic PhD), University of
Department of Ophthalmology (K Ghasemi Falavarjani MD), Air Belgrade, Belgrade, Serbia; Department of Neurosciences
Pollution Research Center (B Heibati PhD), Preventive Medicine and (Prof M A Barboza MD), Area de Estadística, Dirección Actuarial
Public Health Research Center (M Moradi-Lakeh MD, K Vosoughi MD, (Prof J Castillo Rivas MSc), Costa Rican Department of Social Security,
A Tehrani-Banihashemi PhD), Department of Neuroscience San Jose, Costa Rica; School of Medicine (Prof M A Barboza MD),
(M Safdarian MD), Department of Health Policy (H Shabaninejad PhD), School of Dentistry (Prof J Castillo Rivas MSc), University of Costa Rica,
Department of Community Medicine (A Tehrani-Banihashemi PhD), San Pedro, Costa Rica; School of Psychology (Prof S L Barker-Collo PhD),
Physiology Research Center (M Yousefifard PhD), Iran University of Molecular Medicine and Pathology (K B Tran MD), University of
Medical Sciences, Tehran, Iran (T Beyranvand PhD, F Farhadi MD, Auckland, Auckland, New Zealand; Institute of Public Health
M Hosseinzadeh PhD); Stroke Clinic, National Institute of Neurology (Prof T W Bärnighausen MD, B Moazen MSc, S Mohammed PhD),
and Neurosurgery, Mexico City, Mexico (Prof A Arauz DrPH); School of Institute of Global Health (Prof J De Neve MD), Department of
Health Sciences, Birmingham City University, Birmingham, UK Ophthalmology (Prof J B Jonas MD), Medical Clinic V
(O Aremu PhD); School of Health and Social Studies, Dalarna (Prof W März MD), Augenpraxis Jonas (S Panda-Jonas MD), Heidelberg
University, Falun, Sweden (Prof J Ärnlöv PhD); CERIMP, Tuscany University, Heidelberg, Germany; Department of Global Health and
Regional Centre for Occupational Injuries and Diseases, Firenze, Italy Population (Prof T W Bärnighausen MD, Prof O F Norheim PhD),
(F Ariani MSc); Social Determinants of Health Research Center, Saveh Department of Nutrition (M S Farvid PhD), T H Chan School of Public
University of Medical Sciences, Saveh, Iran (B Armoon PhD); School of Health (P C Gupta DSc), Ariadne Labs (E K Macarayan PhD), Division of
Science and Health (A Arora PhD), School of Social Sciences and General Internal Medicine and Primary Care (Prof A Sheikh MD), Heart
Psychology (Prof A M N Renzaho PhD), Western Sydney University, and Vascular Center (M Vaduganathan MD), Harvard University,
Sydney, NSW, Australia (F A Ogbo PhD); Oral Health Services, Sydney Boston, MA, USA (M G Shrime MD); Department of Industrial

Engineering, Pontifical Javeriana University, Bogota, Colombia Bangladesh (M Bin Sayeed MSPS); Global Health Division, Research
(Prof L H Barrero DSc); Melbourne Medical School, Melbourne, VIC, Triangle Institute International, Research Triangle Park, NC, USA
Australia (Prof B T Baune PhD); Department of Psychiatry, (D Bisanzio PhD); School of Medicine, University of Nottingham,
Charles R Drew University of Medicine and Science, Los Angeles, CA, Nottingham, UK (D Bisanzio PhD, F Shokraneh MS); Institute of Bone
USA (Prof S Bazargan-Hejazi BEP); Department of Psychiatry and and Joint Research (M Cross PhD), Sydney School of Public Health
Biobehavioral Sciences, University of California Los Angeles, (Prof T R Driscoll PhD), Sydney Medical School (S Islam PhD), Asbestos
Los Angeles, CA, USA (Prof S Bazargan-Hejazi BEP); Department of Diseases Research Institute (J Leigh MD), University of Sydney,
Community Medicine, Gandhi Medical College Bhopal, Bhopal, India Australia (Prof F M Blyth PhD, D G Hoy PhD, M A Mohammed PhD);
(Prof N Bedi MD); Department of Neuroscience (E Beghi MD, Department of Vital and Health Statistics (H L Harb MPH), Department
G Giussani PhD), Department of Renal Medicine (B Bikbov MD, of Disease, Epidemics, and Pandemics Control (J Nansseu MD),
N Perico MD), Department of Oncology (M Cortinovis PhD), Mario Ministry of Public Health, Beirut, Lebanon (I R Bou-Orm MD);
Negri Institute for Pharmacological Research, Milan, Italy Transport and Road Safety Research (S Boufous PhD), National Drug
(Prof G Remuzzi MD); Social Determinants of Health Research Center and Alcohol Research Centre (Prof L Degenhardt PhD), School of
(M Behzadifar PhD), Lorestan University of Medical Sciences, Medicine (P K Maulik PhD), School of Psychiatry (Prof P B Mitchell MD,
Khorramabad, Iran (M Behzadifar MS); Department of Neurology, Prof P S Sachdev MD), University of New South Wales, Sydney, NSW,
University Hospital of Dijon, Dijon, France (Prof Y Béjot PhD); Dijon Australia; Vision & Eye Research Unit, Anglia Ruskin University,
Stroke Registry – Ufr Sciences Santé, University of Burgundy, Dijon, Cambridge, UK (Prof R Bourne MD); Department for Clinical
France (Prof Y Béjot PhD); Department of Public Health Neurosciences and Preventive Medicine, Danube University Krems,
(Y A Belay MPH), Department of Nursing (G A Dessie MSc, Krems, Austria (Prof M Brainin MD); School of Medicine and Clinical
D H Kassa MSc, F S Wagnew MSc), College of Health Sciences Hospital (Prof L C Brant PhD), Nutrition Department
(G M Kassa MSc), Debre Markos University, Debre Markos, Ethiopia (Prof R M Claro PhD), Department of Maternal and Child Nursing and
(H Temesgen MPH); School of Forestry and Environmental Studies Public Health (Prof D C Malta PhD), Hospital of the Federal University
(Prof M L Bell PhD), Department of Ophthalmology and Visual Science of Minas Gerais (B R Nascimento PhD, Prof A P Ribeiro MD),
(Prof J J Huang MD), Yale University, New Haven, CT, USA; Department Post-Graduate Program in Infectious Diseases and Tropical Medicine
of Medicine, University of Alberta, Edmonton, AB, Canada (B P Sao Jose PhD), Federal University of Minas Gerais, Belo Horizonte,
(A K Bello PhD); Department of Internal Medicine (I M Bensenor PhD, Brazil; Institute of Epidemiology, Comenius University, Bratislava,
Prof I S Santos PhD), Division of Ophthalmology (J M Furtado MD), Slovakia (A Brazinova MD); Department of Psychology
University Hospital, Internal Medicine Department (A C Goulart PhD), (Prof N J K Breitborde PhD), College of Public Health
Department of Medicine (Prof P A Lotufo DrPH), Department of (Prof M Yotebieng PhD), Psychiatry and Behavioral Health Department
Pathology and Legal Medicine (M R Tovani-Palone MSc), Department of (Prof N J K Breitborde PhD), Ohio State University, Columbus, OH,
Psychiatry (Y Wang PhD), Center for Clinical and Epidemiological USA; Division of Clinical Epidemiology and Aging Research, German
Research (A C Goulart PhD), University of São Paulo, São Paulo, Brazil; Cancer Research Center, Heidelberg, Germany (Prof H Brenner MD,
Dental Institute (E Bernabe PhD), Faculty of Life Sciences and Medicine B Schöttker PhD); School of Physiotherapy and Exercise Science
(Prof P I Dargan MB, M Molokhia PhD), St John’s Institute of (Prof A M Briggs PhD), School of Public Health
Dermatology (Prof R J Hay MD), Division of Patient and Population (A T Gebremedhin MPH, D Hendrie PhD, T R Miller PhD), Curtin
(Prof W Marcenes PhD), School of Population Health & Environmental University, Bentley, WA, Australia; Ageing and Life Course
Sciences (Prof C D A Wolfe MD), King’s College London, London, UK; (Prof A M Briggs PhD), Health Information (H Elkout PhD), World
Hubert Department of Global Health, Emory University, Atlanta, GA, Health Organization (WHO), Geneva, Switzerland; Committee for
USA (R S Bernstein MD); Department of Global Health, University of Comprehensive Assessment of Medical Devices and Information
South Florida, Tampa, FL, USA (R S Bernstein MD); Institutes of Technology, Health Technology Assessment Association, Moscow,
Applied Health Research and Translational Medicine, Queen Elizabeth Russia (A N Briko MSc); Neuroscience, Institute for Scientific Research
Hospital Birmingham, Birmingham, UK (N Bhala DPhil); IAHR/ITM, and High Technology Services, City Of Knowledge, Panama
University of Birmingham, Birmingham, UK (N Bhala DPhil); (G Britton PhD); Department of Research and Health Technology
Department of Infectious Disease Epidemiology (O J Brady PhD), Assessment (F Castro MD), Gorgas Memorial Institute for Health
Department of Disease Control (J Cano PhD), Department of Health Studies, Panama, Panama (G Britton PhD, I Moreno Velásquez PhD);
Services Research and Policy (Prof M McKee DSc), Department of Monash Department of Clinical Epidemiology, Cabrini Institute,
Medical Statistics (Prof N Pearce PhD), Department of Melbourne, VIC, Australia (Prof R Buchbinder PhD); Institute of Public
Non-Communicable Disease Epidemiology (Prof D Prabhakaran DM), Health (Prof R Busse PhD, Prof E Schaeffner MD), Department of
London School of Hygiene & Tropical Medicine, London, UK Operative and Preventive Dentistry (Prof F Schwendicke MPH), Charité
(S Bhattarai MD); Nepal Academy of Science & Technology, Patan, Nepal University Medical Center Berlin, Berlin, Germany; School of Population
(S Bhattarai MD); The George Institute for Global Health, New Delhi, and Public Health (Z A Butt PhD, Prof N Sarrafzadegan MD), University
India (S Bhaumik MBBS, Prof V Jha MD, P K Maulik PhD); Center of of British Columbia, Vancouver, BC, Canada (J A Kopec PhD); Al Shifa
Excellence in Women and Child Health, Aga Khan University, Karachi, School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi,
Pakistan (Prof Z A Bhutta PhD); Social Determinants of Health Pakistan (Z A Butt PhD); Department of Population and Health,
Research Center (A Bijani PhD), Health Research Institute Metropolitan Autonomous University, Mexico City, Mexico
(M Ghasemi-Kasman PhD), Department of Immunology (Prof R Cárdenas DSc); Institute of Public Health (Prof F Carvalho PhD),
(M Mohammadnia-Afrouzi PhD), Department of Clinical Biochemistry Institute of Biomedical Engineering (J Das Neves PhD), REQUIMTE/
(N Neamati MSc), Cellular and Molecular Biology Research Center LAQV (Prof E Fernandes PhD, Prof D M Pereira PhD), Department of
(H Nouri PhD), Infectious Diseases and Tropical Medicine Research Community Medicine (J V Santos MD), UCIBIO (J P Silva PhD),
Center (A Rostami PhD), Department of Microbiology and Immunology Applied Molecular Biosciences Unit (Prof F Carvalho PhD), Institute for
(M Shahbazi PhD), Student Research Committee (M Zamani MD), Research and Innovation in Health (J Das Neves PhD), University of
Babol University of Medical Sciences, Babol, Iran (M Faramarzi PhD); Porto, Porto, Portugal; Colombian National Health Observatory
Department of Epidemiology and Biostatistics (V Bilano PhD), (C A Castañeda-Orjuela MD), National Institute on Deafness and Other
Department of Surgery and Cancer (Prof A C Davis PhD), Department Communication Disorders (H J Hoffman MA), National Institute of
of Primary Care and Public Health (Prof A Majeed MD, Health, Bogota, Colombia; Epidemiology and Public Health Evaluation
Prof S Rawaf PhD), WHO Collaborating Centre for Public Health Group (C A Castañeda-Orjuela MD), Department of Public Health
Education and Training (D L Rawaf MD, H Shoman MPH), School of (Prof F P De La Hoz PhD), National University of Colombia, Bogota,
Public Health (Prof S Saxena MD), Division of Brain Sciences Colombia; Department of Health Planning and Economics, Institute of
(Prof T J Steiner PhD), Imperial College London, London, UK; Woldia Health Carlos III, Madrid, Spain (F Catalá-López PhD); Mary MacKillop
University, Woldia, Ethiopia (N Bililign BHlthSci); Department of Institute for Health Research, Australian Catholic University,
Clinical Pharmacy and Pharmacology, University of Dhaka, Ramna, Melbourne, VIC, Australia (Prof E Cerin PhD); School of Public Health

(Prof E Cerin PhD), Centre for Suicide Research and Prevention CO, USA (Prof R P Dellavalle MD); Dermatology Service, US
(Prof P Yip PhD), University of Hong Kong, Hong Kong, China Department of Veterans Affairs (VA), Denver, CO, USA
(Prof P Yip PhD); College of Medicine, Alfaisal University, Riyadh, Saudi (Prof R P Dellavalle MD); Department of Clinical Pharmacy
Arabia (Y Chaiah, Prof Z A Memish MD, M Temsah MRCPCH, (G T Demoz MSc), Department of Medical Laboratory Sciences
O Temsah); Kidney Health Research Institute, Geisinger Health System, (M Teweldemedhin MSc), Aksum University, Aksum, Ethiopia;
Danville, PA, USA (A R Chang MD); Institute of Population Health Information Services Division (G M A Wyper MSc), National Health
Sciences, National Health Research Institutes, Zhunan Township, Service Scotland, Edinburgh, UK (N Dervenis MD); Department of
Taiwan (Prof H Chang DrPH); College of Medicine (J Chang PhD), Ophthalmology (Prof F Topouzis PhD), Aristotle University of
Institute of Epidemiology and Preventive Medicine (Y Wu MSc), Thessaloniki, Thessaloniki, Greece (N Dervenis MD); Department of
National Taiwan University, Taipei, Taiwan; Department of Development Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY,
Studies (A Chattopadhyay PhD), Department of Population Studies USA (Prof D C Des Jarlais PhD); Disha Foundation, Gurgaon, India
(A Patle MPH), Department of Public Health & Mortality Studies (S Dey PhD); Department of Community Medicine, University of
(M H Rahman MPhil, Prof U Ram PhD), International Institute for Peradeniya, Peradeniya, Sri Lanka (S D Dharmaratne MD); Swedish
Population Sciences, Mumbai, India (S Goli PhD); Faculty of Medical Family Medicine – First Hill, Seattle, WA, USA (M A Dirac MD); Deputy
Sciences, University of the West Indies, St Augustine, Trinidad and of Research and Technology (S Djalalinia PhD), Center of
Tobago (V Chattu MD); Independent Consultant, Athens, Greece Communicable Disease Control (B Eshrati PhD), Ministry of Health and
(V Chattu MD); Surgical Oncology, Tata Memorial Hospital, Mumbai, Medical Education, Tehran, Iran (A Khosravi PhD); Center of Excellence
India (Prof P Chaturvedi MD); Clinical Governance, Gold Coast Health, in Health Service Management (L Doan BMedSc), Center for Excellence
Gold Coast, QLD, Australia (P P Chiang PhD); Ministry of Health, in Behavioral Health (L H Nguyen PhD), Center of Excellence in
Baghdad, Iraq (A Chitheer MD); Biochemistry, Biomedical Science, Behavioral Medicine (N B Nguyen MD, S H Nguyen BS), Nguyen Tat
Seoul National University Hospital, Seoul, South Korea (J J Choi PhD); Thanh University, Ho Chi Minh City, Vietnam; Department of Social
Department of Public Health and Primary Care, University of Medicine and Health Care Organisation, Medical University of Varna,
Cambridge, Cambridge, UK (R Chowdhury PhD); Institute of Clinical Varna, Bulgaria (K Dokova PhD); Department of Population and Health,
Medicine and Bispebjerg Hospital (Prof H Christensen DMSci), University of Cape Coast, Cape Coast, Ghana (D T Doku PhD); Faculty of
Department of Neurology (T C Truelsen PhD), University of Social Sciences (D T Doku PhD, S Neupane PhD), University of
Copenhagen, Copenhagen, Denmark; Department of Pulmonary Tampere, Tampere, Finland; University of Rochester, Rochester, NY,
Medicine (Prof D J Christopher MD), Department of Endocrinology USA (E Dorsey MD); School of Health and Biomedical Sciences
(Prof N Thomas PhD), Christian Medical College and Hospital, Vellore, (Prof K E Doyle PhD), Department of Psychology
India (Prof S Varughese MD); Adelaide Medical School (Prof S R Robinson PhD), Royal Melbourne Institute of Technology
(L G Ciobanu PhD, T K Gill PhD), University of Adelaide, Adelaide, SA, University, Bundoora, VIC, Australia; United Nations World Food
Australia (A T Olagunju MD); Scuola Medica Salernitana, University of Programme, New Delhi, India (M Dubey PhD); School of Medicine,
Salerno, Baronissi, Italy (M Cirillo MD); Faculty of Education Federal University of Bahia, Salvador, Brazil (Prof A R Duraes PhD);
(D Collado-Mateo MSc), Institute of Physical Activity and Health Diretoria Médica, Roberto Santos General Hospital, Salvador, Brazil
(Prof P R Olivares PhD), Autonomous University of Chile, Talca, Chile; (Prof A R Duraes PhD); Department of Nursing, Umeå University,
NIHR Oxford Biomedical Research Centre (Prof C Cooper MEd), Umeå, Sweden (Prof D Edvardsson PhD); Clinical Epidemiology and
University of Southampton, Southampton, UK (Prof C Cooper MEd); Biostatistics, University of Newcastle, Newcastle, NSW, Australia
School of Medicine and Surgery, University of Milan Bicocca, Monza, (A Effiong MB); Institute for Health Care Policy and Innovation
Italy (P A Cortesi PhD, A Lafranconi MD, F Madotto PhD, (J R Ehrlich MD), Department of Ophthalmology and Visual Sciences
Prof L G Mantovani DSc); T Denny Sanford School of Social and Family (J R Ehrlich MD), University of Michigan, Ann Arbor, MI, USA;
Dynamics, Arizona State University, Tempe, AZ, USA (M Costa PhD); Department of Community Medicine, Tripoli University, Libya
Division of Reproductive Health, Centers for Disease Control and (H Elkout PhD); Eijkman-Oxford Clinical Research Unit, Eijkman
Prevention (CDC), Atlanta, GA, USA (M Costa PhD); Postgraduate Institute for Molecular Biology, Jakarta, Indonesia (I R F Elyazar PhD);
Program in Epidemiology, Federal University of Rio Grande do Sul, Public Health Department, Saint Paul’s Hospital Millennium Medical
Porto Alegre, Brazil (E Cousin MS, B B Duncan MD, College, Addis Ababa, Ethiopia (A Y Endries MPH); Epidemiology &
Prof B N G Goulart DSc, Prof M I Schmidt PhD); Department of Family Disease Control (S Ma PhD), Ministry of Health, Singapore, Singapore
Medicine and Public Health, University of California San Diego, La Jolla, (B Er MSc); Policy and Epidemiology Group (D F Santomauro PhD),
CA, USA (Prof M H Criqui MD); Centre for International Health Child and Youth Mental Health (J G Scott PhD), Queensland Centre for
(Prof J A Crump MD), Department of Medicine (A Ranta PhD), Mental Health Research, Brisbane, QLD, Australia (H E Erskine PhD,
University of Otago, Dunedin, New Zealand; Division of Infectious A J Ferrari PhD); Department of Medical Parasitology and Mycology,
Diseases and International Health (Prof J A Crump MD), Duke Global Urmia University of Medical Science, Urmia, Iran (H Fakhim PhD);
Health Institute (L L Yan PhD), Duke University, Durham, NC, USA; College of Medicine (M Fareed PhD), Department of Public Health
Discipline of Public Health, Flinders University, Adelaide, SA, Australia (A T Khoja MD), Imam Muhammad Ibn Saud Islamic University,
(A F Dadi MPH); Clinical Toxicology Service (Prof P I Dargan MB), Riyadh, Saudi Arabia; Division of Cardiovascular Medicine, University of
Biomedical Research Council (Prof C D A Wolfe MD), Guy’s and Louisville, Louisville, KY, USA (T A Farid MD, N V Singam MD);
St Thomas’ NHS Foundation Trust, London, UK; James P Grant School National Statistical Office, Lisbon, Portugal (C S E Farinha MSc);
of Public Health (R Das Gupta MPH, M Hasan MPH, Department of Medical and Surgical Sciences, University of Bologna,
I Sutradhar MPH), Research and Evaluation Division (M Rahman PhD), Bologna, Italy (A Farioli PhD, Prof F S Violante MPH); Department of
BRAC University, Dhaka, Bangladesh; Department of Global Health and Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
Infection, Brighton and Sussex Medical School, Brighton, UK (Prof A Faro PhD); National Institute for Stroke and Applied
(Prof G Davey MD, K Deribe PhD); Ear Institute (Prof A C Davis PhD), Neurosciences, Auckland University of Technology, Auckland,
Institute for Global Health (H Haghparast Bidgoli PhD), Department of New Zealand (Prof V L Feigin PhD); Center for Biotechnology and Fine
Epidemiology and Public Health (Prof M Kivimäki PhD, Chemistry, Catholic University of Portugal, Porto, Portugal
M R Mathur PhD), Department of Psychology (M Kumar PhD), Division (J C Fernandes PhD); Psychiatry, Kaiser Permanente, Fontana, CA, USA
of Medicine (K Saleem MSc), University College London, London, UK; (I Filip MD); Department of Health Sciences (I Filip MD), A T Still
Department of Surgery, Clinical Emergency Hospital Sf Pantelimon, University, Mesa, Arizona, USA (A Radfar MD, M Soosaraei PhD);
Bucharest, Romania (D V Davitoiu PhD); Department of Diabetes and Department of Public Health Medicine, Bielefeld University, Bielefeld,
Vascular Medicine, Monash Health, Melbourne, VIC, Australia Germany (F Fischer PhD); Institute of Gerontology, National Academy
(B De Courten PhD); Australian Institute for Suicide Research and of Medical Sciences of Ukraine, Kyiv, Ukraine (N A Foigt PhD); Gene
Prevention (Prof D De Leo DSc), Menzies Health Institute Queensland Expression & Regulation Program, Cancer Institute, Philadelphia, PA,
(S K Tadakamadla PhD), Griffith University, Mount Gravatt, QLD, USA (T Fukumoto PhD); Department of Dermatology, Kobe University,
Australia; School of Medicine, University of Colorado Denver, Aurora, Kobe, Japan (T Fukumoto PhD); Epidemiology and Public Health

(T Fürst PhD), Malaria Vaccines (C Karema MPH), Swiss Tropical and Health and Environmental Studies, Hamdan Bin Mohammed Smart
Public Health Institute, Basel, Switzerland; University of Basel, Basel, University, Dubai, United Arab Emirates (Prof S Hamidi DrPH);
Switzerland (T Fürst PhD); Menzies Institute for Medical Research, Population Health Department, University of New Mexico, Albuquerque,
University of Tasmania, Hobart, TAS, Australia (S Gall PhD); Faculty of NM, USA (A J Handal PhD); Neurology Department, Sir Charles
Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Gairdner Hospital, Perth, WA, Australia (Prof G J Hankey MD);
Abdellah, Fez, Morocco (F G Gankpe MD); Tuberculosis, Manhiça Sun Yat-sen Global Health Institute (Prof Y Hao PhD), Department of
Health Research Center, Manhiça, Mozambique Medical Statistics and Epidemiology (Y Liao PhD, Prof Y Hao PhD), Sun
(A L Garcia-Basteiro MD); Tuberculosis Department Yat-sen University, Guangzhou, China; Cardiology Department
(A L Garcia-Basteiro MD), Barcelona Institute for Global Health, (Prof S Harikrishnan MD), Achutha Menon Centre for Health Science
Barcelona, Spain (Prof J V Lazarus PhD); Division of Human Nutrition Studies (P Jeemon PhD, G Mini PhD, Prof K R Thankappan MD), Sree
and Health, Wageningen University & Research, Wageningen, Chitra Tirunal Institute for Medical Sciences and Technology,
Netherlands (Prof J M Geleijnse PhD); Directorate General for Public Trivandrum, India; Research and Development Unit, San Juan de Dios
Health, Regional Health Council, Madrid, Spain Sanitary Park, Sant Boi De Llobregat, Spain (Prof J M Haro MD,
(R Genova-Maleras MSc); Centre for Tropical Medicine and Global A Koyanagi MD); Department of Medicine, University of Barcelona,
Health (S Lewycka PhD), Nuffield Department of Medicine Barcelona, Spain (Prof J M Haro MD); Health Education and Health
(Prof P W Gething PhD, D J Weiss PhD), The Big Data Institute Promotion Department, School of Public Health (L Jahangiry PhD),
(T C D Lucas PhD), Department of Psychiatry (Prof C R J Newton MD), Tabriz University of Medical Sciences, Tabriz, Iran
Nuffield Department of Women’s and Reproductive Health (H Hassankhani PhD); Independent Consultant, Tabriz, Iran
(Prof K Rahimi MD), University of Oxford, Oxford, UK (Prof V Jha MD); (H Hassankhani PhD); Public Health Department (H Y Hassen MPH),
Department of Health Care Policy and Management, University of Mizan-Tepi University, Teppi, Ethiopia (A Henok MPH); Unit of
Tsukuba, Tsukuba, Japan (M Ghimire MA); Institute for Global Health Epidemiology and Social Medicine, University Hospital Antwerp,
Sciences (R Ghosh PhD), Department of Epidemiology and Biostatistics Wilrijk, Belgium (H Y Hassen MPH); Clinical Sciences, Karolinska
(K M Mehta DSc), University of California San Francisco, San Francisco, University Hospital, Stockholm, Sweden (R Havmoeller PhD);
CA, USA; Department of Respiratory Medicine, National Allergy, International Foundation for Dermatology, London, UK
Asthma, and Bronchitis Institute, Kolkota, India (Prof R J Hay MD); Department of Statistics and Econometrics
(Prof A G Ghoshal MD); Department of Respiratory Medicine, Fortis (Prof C Herteliu PhD, B Ileanu PhD, A Pana MD), Bucharest University
Hospital, Kolkata, India (Prof A G Ghoshal MD); Department of of Economic Studies, Bucharest, Romania; Department of Reproductive
Cardiovascular, Dysmetabolic, and Ageing-Associated Diseases, National Health (D T Hibstu MPH), Department of Pediatrics (B T Tadesse MD),
Public Health Institute, Rome, Italy (S Giampaoli MD); Department of Hawassa University, Hawassa, Ethiopia; Department of Psychiatry,
Public Health, Texas Tech University, Lubbock, TX, USA University Medical Center Groningen, Groningen, Netherlands
(S Giampaoli MD); Unit of Academic Primary Care (Prof P S Gill DM), (Prof H W Hoek MD); Department of Epidemiology
Division of Health Sciences (O A Uthman PhD), University of Warwick, (Prof H W Hoek MD), Department of Health and Behavior Studies
Coventry, UK; Department of Family and Community Medicine, (Prof I D Sigfusdottir PhD), Columbia University, New York, NY, USA;
University of Hail, Hail, Saudi Arabia (Prof I A Ginawi MD); Research Division of Scientific Programs (H J Hoffman MA), Center for
Center of Neurology, Moscow, Russia (E V Gnedovskaya PhD, Translation Research and Implementation Science (G A Mensah MD),
M A Kravchenko PhD, Prof M A Piradov DSc); Center for the Study of National Institutes of Health, Bethesda, MD, USA; University of Texas
Regional Development, Jawahar Lal Nehru University, New Delhi, India Austin, Austin, TX, USA (M K Hole MD); School of Health
(S Goli PhD); Nursing and Health Sciences Department, University of (E Homaie Rad PhD), Guilan Road Trauma Research Center
Massachusetts Boston, Boston, MA, USA (P N Gona PhD); Department (E Homaie Rad PhD), Guilan University of Medical Sciences, Rasht,
of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma Iran; Transdisciplinary Centre for Qualitative Methods, Manipal
City, OK, USA (S V Gopalani MPH); Department of Health and Social University, Manipal, India (P Hoogar PhD); Department of Computer
Affairs, Government of the Federated States of Micronesia, Palikir, Science, University of Human Development, Sulaimaniyah, Iraq
Federated States of Micronesia (S V Gopalani MPH); School of (M Hosseinzadeh PhD); Department of Internal Medicine, Bucharest
Medicine, Boston University, Boston, MA, USA (A Grada MD); Registro Emergency Hospital, Bucharest, Romania (M Hostiuc PhD); Clinical
Tumori Integrato, Vittorio Emanuele University Hospital Polyclinic, Legal Medicine, National Institute of Legal Medicine Mina Minovici,
Catania, Italy (G Grosso PhD); Department of Epidemiology Bucharest, Romania (S Hostiuc PhD); National School of Tropical
(Prof H C Gugnani PhD), Department of Microbiology Medicine, Baylor College of Medicine, Houston, TX, USA
(Prof H C Gugnani PhD), Saint James School of Medicine, The Valley, (Prof P J Hotez PhD); Faculty of Medicine Tunis, Medicine School of
Anguilla; Department of Epidemiology, Healis Sekhsaria Institute for Tunis, Baab Saadoun, Tunisia (Prof M Hsairi MPH); International
Public Health, Mumbai, India (P C Gupta DSc, D N Sinha PhD); Relations Division, Ministry of Health and Sports, Myanmar
Commissioner of Public Health, West Virginia Bureau for Public Health, (A Htet MD); Institute of Health and Society (A Htet MD,
Charleston, WV, USA (Prof R Gupta MD); Department of Health Policy, A S Winkler PhD), Department of Health Management and Health
Management & Leadership, West Virginia University School of Public Economics (Prof A Kisa PhD), University of Oslo, Oslo, Norway;
Health, Morgantown, WV, USA (Prof R Gupta MD); Academics and Department of Epidemiology and Health Statistics, Central South
Research, Rajasthan University of Health Sciences, Jaipur, India University, Changsha, China (Prof G Hu PhD); Health Outcomes
(Prof R Gupta MD); Department of Preventive Cardiology, Eternal Heart (A Pana MD), Center for Health Outcomes & Evaluation, Bucharest,
Care Centre & Research Institute, Jaipur, India (Prof R Gupta MD); Romania (B Ileanu PhD); Department of Public Health and Community
Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA Medicine (O S Ilesanmi PhD), University of Liberia, Monrovia, Liberia;
(T Gupta MD); Department of Epidemiology and Population Health Global Health and Development Department (Prof U Iqbal PhD),
(H Hosgood PhD), Albert Einstein College of Medicine, Bronx, NY, USA Graduate Institute of Biomedical Informatics (D N A Ningrum MPH),
(T Gupta MD); Department of Public Health (B Gyawali MPH, Taipei Medical University, Taipei City, Taiwan, Taiwan; Institute for
K M Iburg PhD), National Centre for Register-based Research Physical Activity and Nutrition (S Islam PhD), School of Medicine
(Prof J J McGrath MD, O Plana-Ripoll PhD), Aarhus University, Aarhus, (M Rahman PhD), Department of Psychology (M A Stokes PhD), Deakin
Denmark; Department of Public Health, Erasmus University Medical University, Burwood, VIC, Australia; Surveillance and Health Services
Center, Rotterdam, Netherlands (J A Haagsma PhD, S Kochhar MD, Research, American Cancer Society, Atlanta, GA, USA (F Islami PhD);
S Polinder MA); Department of Clinical Neurological Sciences Department of Global and Community Health, George Mason
(V Hachinski DSc), Clinical Neurological Sciences (L A Sposato MD), University, Fairfax, VA, USA (K H Jacobsen PhD); Department of
The University of Western Ontario, London, ON, Canada; Lawson Parasitic Diseases, National Centre for Disease Control Delhi, Delhi,
Health Research Institute, London, ON, Canada (V Hachinski DSc); India (S K Jain MD); Medical Sciences Department, University of
Department of Family and Community Medicine, Arabian Gulf Kragujevac, Kragujevac, Serbia (Prof M Jakovljevic PhD); Newcastle
University, Manama, Bahrain (Prof R R Hamadeh DPhil); School of University, Tyne, UK (M Javanbakht PhD); Faculty of Graduate Studies

(A U Jayatilleke PhD), Institute of Medicine (A U Jayatilleke PhD), Boston, MA, USA (Prof D Kim DrPH); Department of Preventive
University of Colombo, Colombo, Sri Lanka; Department of Community Medicine, Korea University, Seoul, South Korea (Y Kim PhD,
Medicine, Banaras Hindu University, Varanasi, India (R P Jha MSc); Prof S Yoon PhD); School of Medicine, Xiamen University Malaysia,
Environmental Research Center (J S Ji DSc), Global Health Research Sepang, Malaysia (Y Kim PhD); Department of Nutrition, Simmons
Center (L L Yan PhD), Duke Kunshan University, Kunshan, China; College, Boston, MA, USA (R W Kimokoti MD); Faculty of Health,
Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, University of Canberra, Canberra, ACT, Australia (Y Kinfu PhD);
China (Prof J B Jonas MD); Faculty of Medicine and Health Sciences Department of Global Community Health and Behavioral Sciences,
(J J Jozwiak PhD), Department of Family Medicine and Public Health Tulane University, New Orleans, LA, USA (Prof A Kisa PhD);
(J J Jozwiak PhD), University of Opole, Opole, Poland; School of Health Department of Health Economics and Social Security
Sciences, Savitribai Phule Pune University, Pune, India (K Kissimova-Skarbek PhD), Institute of Public Health
(S B Jungari MA); Institute of Family Medicine and Public Health, (R Topor-Madry PhD), Jagiellonian University Medical College, Krakow,
University of Tartu, Tartu, Estonia (M Jürisson PhD); School of Public Poland; Department of Public Health (Prof M Kivimäki PhD,
Health, University College Cork, Cork, UK (Z Kabir PhD); Personal T Lallukka PhD), University of Helsinki, Helsinki, Finland
Social Services Research Unit, London School of Economics and Political (T J Meretoja MD); Centre for Disease Burden (A S Knudsen PhD),
Science, London, UK (R Kadel MPH); Department of Forensic Medicine Division of Mental and Physical Health (Prof S Øverland PhD),
and Toxicology (T Kanchan MD), Department of Paediatrics Norwegian Institute of Public Health, Bergen, Norway; Department of
(Prof R Lodha MD), Department of Cardiology (Prof N Naik DM, Psychosocial Science (A S Knudsen PhD, Prof S Øverland PhD),
Prof A Roy MD), Department of Psychiatry (Prof R Sagar MD), Department of Global Public Health and Primary Care
Department of Endocrinology, Metabolism, & Diabetes (Prof O F Norheim PhD), University of Bergen, Bergen, Norway; Public
(Prof N Tandon PhD), All India Institute of Medical Sciences, Jodhpur, Health Sciences Division, Fred Hutchinson Cancer Research Center,
India; Department of Epidemiology (M Karami PhD), Department of Seattle, WA, USA (J M Kocarnik PhD); Department of Preventive
Environmental Health Engineering (M Khazaei PhD), Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
Biostatistics (N M G Mezerji MSc), Chronic Diseases (Home Care) (Prof Y Kokubo PhD); Arthritis Research Canada, Richmond, BC,
Research Center (M Shamsizadeh MSc), Hamadan University of Canada (J A Kopec PhD); Independent Consultant, Jakarta, Indonesia
Medical Sciences, Hamadan, Iran; Department for Epidemiology, (S Kosen MD); Department of Internal and Pulmonary Medicine, Sheri
Helmholtz Centre for Infection Research, Braunschweig, Germany Kashmir Institute of Medical Sciences, Srinagar, India
(A Karch MD); Quality and Equity Health Care, Kigali, Rwanda (Prof P A Koul MD); Department of Anthropology, Panjab University,
(C Karema MPH); School of Interdisciplinary Arts and Sciences, Chandigarh, India (K Krishan PhD); Department of Social and
University of Washington Tacoma, Tacoma, WA, USA (S Karimi PhD); Preventive Medicine (Prof B Kuate Defo PhD), Department of
Department of Anesthesiology & Pain Medicine, Seattle Children’s Demography (Prof B Kuate Defo PhD), University of Montreal,
Hospital, Seattle, WA, USA (N J Kassebaum MD); MRC/CSO Social and Montreal, QC, Canada; Department of Public Health, Yuksek Ihtisas
Public Health Sciences Unit, University of Glasgow, Glasgow, UK University, Ankara, Turkey (B Kucuk Bicer BEP); Department of Public
(S V Katikireddi PhD); ODeL Campus (Prof P N Keiyoro PhD), Health, Hacettepe University, Ankara, Turkey (B Kucuk Bicer BEP);
University of Nairobi, Nairobi, Kenya (M Kumar PhD); Department of Department of Internal Medicine (D P Lad DM), Department of
Linguistics and Germanic, Slavic, Asian, and African Languages, Pediatrics (S D Lad MD), Post Graduate Institute of Medical Education
Michigan State University, East Lansing, MI, USA (G R Kemp BA); and Research, Chandigarh, India; Population and Work Ability Program
Non-Communicable Diseases Research Unit (Prof A P Kengne PhD), (T Lallukka PhD), Finnish Institute of Occupational Health, Helsinki,
Alcohol, Tobacco, & Other Drug Use Research Unit Finland (R Shiri PhD); Department of Community and Family Medicine,
(Prof C D H Parry PhD), Cochrane South Africa (A B Wiyeh MD, Academy of Medical Science, Baghdad, Iraq (F H Lami PhD);
Prof C S Wiysonge MD), Medical Research Council South Africa, Cape HelpMeSee, New York, NY, USA (Prof V C Lansingh PhD); International
Town, South Africa; Department of Medicine (Prof A P Kengne PhD, Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
G A Mensah MD, J Noubiap MD, Prof K Sliwa MD), Department of (Prof V C Lansingh PhD); Department of Public Health (A Latifi PhD),
Psychiatry and Mental Health (Prof D J Stein MD), University of Cape Managerial Epidemiology Research Center (S Safiri PhD), Maragheh
Town, Cape Town, South Africa; Institute of Cardiology, Assuta Hospital, University of Medical Sciences, Maragheh, Iran; College of Optometry,
Tel Aviv Yaffo, Israel (Prof A Keren MD); Heart Failure and Nova Southeastern University, Fort Lauderdale, FL, USA
Cardiomyopathies Center, Hadassah Hebrew University Hospital, (J L Leasher OD); Regional Centre for the Analysis of Data on
Jerusalem, Israel (Prof A Keren MD); Department of Public Health and Occupational and Work-Related Injuries and Diseases, Local Health
Community Medicine, Jordan University of Science and Technology, Unit Tuscany Centre, Florence, Italy (M Levi PhD); Department of
Ramtha, Jordan (Prof Y S Khader PhD); Department of Statistics, Azad Health Sciences, University of Florence, Florence, Italy (M Levi PhD);
University, Omidiyeh Branch, Iran (B Khafaei PhD); Epidemiology and Oxford University Clinical Research Unit, Wellcome Trust Asia
Biostatistics Department, Health Services Academy, Islamabad, Pakistan Programme, Hanoi, Vietnam (S Lewycka PhD); Department of Clinical
(E A Khan MPH); Department of Internal Medicine, John H Stroger Jr Research and Epidemiology, Shenzhen Sun Yat-Sen Cardiovascular
Hospital of Cook County, Chicago, IL, USA (M S Khan MD); Hospital, Shenzhen, China (Y Li PhD); Alliance for Improving Health
Department of Internal Medicine, Dow University of Health Sciences, Outcomes, Inc, Quezon City, Philippines (Y Liao PhD); Department of
Karachi, Pakistan (M S Khan MD, T J Siddiqi MB, M S Usman MB); Public Health, Samara University, Samara, Ethiopia (M L Liben MPH);
Department of Epidemiology (G Naik MPH, J A Singh MD), Department Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
of Medicine (P Ranjan PhD, J A Singh MD), Department of Psychology (L Lim MD); Department of Medicine and Therapeutics, The Chinese
(D C Schwebel PhD), University of Alabama at Birmingham, University of Hong Kong, Shatin, China (L Lim MD); Centre for Chronic
Birmingham, AL, USA (M Khan MD, A R Sawant MD); Department of Disease Control, Beijing, China (Prof S Liu PhD); Population Health
Pediatrics (Prof J A Towbin MD), University of Tennessee, Knoxville, TN, Sciences, Bristol Medical School, University of Bristol, Bristol, UK
USA (M Khan MD); Institute of Health Policy and Management (K J Looker PhD); Department of Paediatrics (M T Mackay PhD,
(Prof Y Khang MD), Department of Health Policy and Management Prof G C Patton MD), School of Health Sciences (A Meretoja MD),
(Prof Y Khang MD), Seoul National University, Seoul, South Korea; School of Population and Global Health (Prof H R Taylor MD),
International Otorhinolaryngology Research Association, Tehran, Iran Department of Medicine (Prof T Wijeratne MD), University of
(M Khosravi MD); Clinical Epidemiology Unit (A A Kiadaliri PhD), Melbourne, Melbourne, QLD, Australia (Prof A D Lopez PhD); Institute
Department of Clinical Sciences (Prof B Norrving PhD), Lund of Nutrition, Friedrich Schiller University Jena, Jena, Germany
University, Lund, Sweden; Research Department, Kenya Revenue (Prof S Lorkowski PhD); Competence Cluster for Nutrition and
Authority, Nairobi, Kenya (D N Kiirithio MSc); Research and Data Cardiovascular Health (NUTRICARD), Jena, Germany
Solutions, Synotech Consultant, Nairobi, Kenya (D N Kiirithio MSc); (Prof S Lorkowski PhD); Institute of Social and Preventive Medicine,
Korea Health Industry Development Institute, Cheongju-Si, South Korea University of Bern, Bern, Switzerland (Prof N Low MD); General
(C Kim PhD); Department of Health Sciences, Northeastern University, Surgery Department, Aintree University Hospital National Health

Service Foundation Trust (NHS), Liverpool, UK (R Lunevicius PhD); Community Medicine (M B Sufiyan MD), Ahmadu Bello University,
Surgery Department, University of Liverpool, Liverpool, UK Zaria, Nigeria; Clinical Epidemiology and Public Health Research Unit,
(R Lunevicius PhD); Health Data Research UK, Swansea University, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
Swansea, UK (Prof R A Lyons MD); Saw Swee Hock School of Public (L Monasta DSc, L Ronfani PhD); Department of Epidemiology and
Health (S Ma PhD), Yong Loo Lin School of Medicine Biostatistics (G Moradi PhD), Social Determinants of Health Research
(Prof N Venketasubramanian MBBS), National University of Singapore, Center (G Moradi PhD), Kurdistan University of Medical Sciences,
Singapore (Z Zhao MSc); Neurology Department (M T Mackay PhD), Sanandaj, Iran; Lancaster University, Lancaster, UK (P Moraga PhD);
Cardiology Department (R G Weintraub MB), Royal Children’s Hospital, International Laboratory for Air Quality and Health
Melbourne, VIC, Australia; Cardiology, Damietta University, Damietta, (Prof L Morawska PhD), Australian Centre for Health Services
Egypt (H Magdy Abd El Razek MD); Ophthalmology Department, Aswan Innovation (R Pacella PhD), School of Exercise and Nutrition Sciences
Faculty of Medicine, Aswan, Egypt (M Magdy Abd El Razek MB); (Q G To PhD), Queensland University of Technology, Brisbane, QLD,
Department of Internal Medicine, Grant Medical College & Sir J J Group Australia; Hospital de Sto António, Hospital Center of Porto, Porto,
of Hospitals, Mumbai, India (D P Maghavani MBBS); Institute of Portugal (J Morgado-Da-Costa MSc); 1st Department of Ophthalmology,
Medicine, Tribhuvan University, Kathmandu, Nepal (N B Mahotra MD); University of Athens, Athens, Greece (M M Moschos PhD); Biomedical
Institute for Global Health Innovations, Duy Tan University, Hanoi, Research Foundation, Academy of Athens, Athens, Greece
Vietnam (H T Mai MPH, H L T Nguyen MPH, H Q Pham MD); (M M Moschos PhD); Demographic Change and Ageing Research Area
Department of Public Health, Trnava University, Trnava, Slovakia (A Werdecker PhD), Federal Institute for Population Research,
(M Majdan PhD); Non-Communicable Diseases Research Center, Shiraz Wiesbaden, Germany (Prof U O Mueller MD); Center for Population and
University of Medical Sciences, Shiraz, Iran (Prof R Malekzadeh MD, Health, Wiesbaden, Germany (Prof U O Mueller MD); Department of
S G Sepanlou MD); Surgery Department, Emergency University Endocrinology & Metabolism, Institute of Post Graduate Medical
Hospital Bucharest, Bucharest, Romania (A Manda MD); Department of Education & Research, Kolkata, India (Prof S Mukhopadhyay MD);
Population Studies, University of Zambia, Lusaka, Zambia National Institute of Epidemiology, Chennai, India (M Murhekar MD);
(C Mapoma PhD); Campus Caucaia, Federal Institute of Education, Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
Science and Technology of Ceará, Caucaia, Brazil (J Musa MD); Center for Global Health (J Musa MD), Department of
(F R Martins-Melo PhD); Clinical Institute of Medical and Chemical Preventive Medicine (Y Yano MD), Northwestern University, Chicago,
Laboratory Diagnostics, Medical University of Graz, Graz, Austria IL, USA; School of Medical Sciences, Science University of Malaysia,
(Prof W März MD); Graduate School, University of the East Ramon Kubang Kerian, Malaysia (K Musa PhD); Pediatrics Department, Nishtar
Magsaysay Memorial Medical Center, Quezon City, Philippines Medical University, Multan, Pakistan (Prof G Mustafa MD); Pediatrics &
(M B Marzan MSc); Department of Public Health Medicine, University Pediatric Pulmonology, Institute of Mother & Child Care, Multan,
of Kwazulu-Natal, South Africa (T P Mashamba-Thompson PhD, Pakistan (Prof G Mustafa MD); Department of Obstetrics and
Y Moodley PhD, Prof B Sartorius PhD); Department of Biology and Gynecology (Prof A F Nabhan PhD), Department of Entomology
Biological Engineering, Chalmers University of Technology, (A M Samy PhD), Ain Shams University, Cairo, Egypt; National Center
Gothenburg, Sweden (M Mazidi PhD); Department of Ophthalmology, for Child Health and Development, Setagaya, Japan (C Nagata PhD);
Hywel Dda University Health Board, Carmarthen, UK Initiative for Non Communicable Diseases (A Naheed PhD), Health
(C McAlinden PhD, E Skiadaresi MD); Neurology Department, Economics and Financing Research Group (A R Sarker MHE), Maternal
Janakpuri Super Specialty Hospital Society, New Delhi, India and Child Health Division (S Zaman MPH), International Centre for
(Prof M Mehndiratta MD); Preventive Oncology, National Institute of Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Cancer Prevention and Research, Noida, India (Prof R Mehrotra PhD); Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
Department of Internal Medicine, Sevenhills Hospital, Mumbai, India (Prof L Naldi MD); Direction, Gised Study Center, Bergamo, Italy
(V Mehta MD); College of Health Sciences, Debre Tabor University, (Prof L Naldi MD); Department of Preventive Medicine and Public
Debre Tabor, Ethiopia (A Melese MSc); Division of Rheumatology, Health, Chungnam National University School of Medicine, Daejeon,
Thomas Jefferson University, Philadelphia, PA, USA (M Meltzer MD); South Korea (Prof H Nam PhD); Daejeon Regional Cancer Center,
Department of Public Health, University of West Florida, Pensacola, FL, Chungnam National University Hospital, Daejeon, South Korea
USA (P T N Memiah DrPH); Research Department Prince Mohammed (Prof H Nam PhD); Suraj Eye Institute, Nagpur, India (V Nangia MD);
Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia Department of Public Heath (J Nansseu MD), Department of Internal
(Prof Z A Memish MD); Peru Country Office, United Nations Population Medicine and Specialties (Prof E Sobngwi PhD), University of Yaoundé I,
Fund (UNFPA), Lima, Peru (W Mendoza MD); Department of Yaoundé, Cameroon; Department of Nephrology, Madras Medical
Pharmacy, Wollo University, Dessie, Ethiopia (G Mengistu MSc); College, Chennai, India (Prof G Natarajan BEP); Department of
Neurocenter (A Meretoja MD), Breast Surgery Unit (T J Meretoja MD), Cardiology, Cardio-Aid, Bucharest, Romania (R I Negoi PhD);
Helsinki University Hospital, Helsinki, Finland; Clinical Microbiology Department of Neurosciences, Kenya Medical Research Institute/
and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia Wellcome Trust Research Programme, Kilifi, Kenya
(T Mestrovic PhD); University Centre Varazdin, University North, (Prof C R J Newton MD); Department of Biological Sciences, University
Varazdin, Croatia (T Mestrovic PhD); Department of Hypertension of Embu, Embu, Kenya (J W Ngunjiri DrPH); Health Economics and
(Prof T Miazgowski MD), Zdroje Hospital (J Widecka PhD), Emergency Finance (A Q Nguyen PhD), Department of Health Economics
Department (B Miazgowski MD), Pomeranian Medical University, (H T Nguyen MSc), Hanoi School of Public Health, Hanoi, Vietnam
Szczecin, Poland (B Miazgowski MD); Pacific Institute for Research & (H T Hoang MSc, H T Nguyen PhD); Public Health Science
Evaluation, Calverton, MD, USA (T R Miller PhD); Nevada Division of Department, State University of Semarang, Kota Semarang, Indonesia
Public and Behavioral Health, Carson City, NV, USA (D N A Ningrum MPH); National Department of Health, South African
(M Mirarefin MPH); Faculty of General Medicine, Kyrgyz State Medical Embassy, Pretoria, South Africa (N Nolutshungu MD); Institute for
Academy, Bishkek, Kyrgyzstan (Prof E M Mirrakhimov MD); Global Health Policy Research, National Center for Global Health and
Department of Atherosclerosis and Coronary Heart Disease, National Medicine, Shinjuku-ku, Japan (S Nomura MSc); University of Social
Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan Welfare and Rehabilitation Sciences, Iran (M Noroozi PhD);
(Prof E M Mirrakhimov MD); Institute of Addiction Research, Frankfurt Independent Consultant, Accra, Ghana (R Ofori-Asenso MSc);
University of Applied Sciences, Frankfurt, Germany (B Moazen MSc); Department of Preventive Medicine, Kyung Hee University,
Department of Biology, Salahaddin University, Erbil, Iraq Dongdaemun-gu, South Korea (I Oh PhD); Department of HIV/AIDS,
(K A Mohammad PhD); Ishik University, Erbil, Iraq STIs & TB, Human Sciences Research Council, Durban, South Africa
(K A Mohammad PhD); Cardiovascular Research Institute, Isfahan (O Oladimeji MD); School of Public Health, University of Namibia,
University of Medical Sciences, Isfahan, Iran (N Mohammadifard PhD, Oshakati Campus, Namibia (O Oladimeji MD); Department of
Prof N Sarrafzadegan MD); Department of Public Health, Jigjiga Psychiatry, University of Lagos, Lagos, Nigeria (A T Olagunju MD);
University, Jigjiga, Ethiopia (M A Mohammed PhD); Health Systems Centre for Healthy Start Initiative, Ikoyi, Nigeria (B O Olusanya PhD);
and Policy Research Unit (S Mohammed PhD), Department of NCD Prevention & Control Unit, Ministry of Health, Bandar Seri

Begawan, Brunei (S Ong FAMS); Institute of Health Science, University Inflammation Research Center (A Sahebkar PhD), Biotechnology
of Brunei Darussalam, Gadong, Brunei (S Ong FAMS); Graduate School Research Center (A Sahebkar PhD), Mashhad University of Medical
of Public Health, San Diego State University, San Diego, CA, USA Sciences, Mashhad, Iran; College of Medicine, Al-Imam Mohammad
(Prof E Oren PhD); School of Medicine (Prof A Ortiz MD), Pneumology Ibn Saud Islamic University, Riyadh, Saudi Arabia (N Salam PhD);
Service (Prof J B Soriano MD), Autonomous University of Madrid, School of Health and Policy Management, Faculty of Health, York
Madrid, Spain; Department of Nephrology and Hypertension, The University, Toronto, ON, Canada (Prof P Salamati MD); Medical and
Institute for Health Research Foundation Jiménez Díaz University Human Science Department, University of Manchester, Manchester, UK
Hospital, Madrid, Spain (Prof A Ortiz MD); Department of Global (K Saleem MSc); Punjab University College of Pharmacy, Anarkali,
Health Nursing, St Luke’s International University, Chuo-ku, Japan Pakistan (Z Saleem PharmD); Center for Health Policy & Center for
(Prof E Ota PhD); The Center for Healthcare Quality Assessment and Primary Care and Outcomes Research, Stanford University, Stanford,
Control, Ministry of Health of the Russian Federation, Moscow, Russia CA, USA (Prof J A Salomon PhD); Clinical Research Division, Chest
(S S Otstavnov PhD); Moscow Institute of Physics and Technology, Research Foundation, Pune, India (Prof S S Salvi MD); Health and
Moscow State University, Dolgoprudny, Russia (S S Otstavnov PhD); Disability Intelligence Group, Ministry of Health, Wellington,
Institute for Advanced Medical Research and Training, University of New Zealand (I Salz MD); Department of Surgery, Marshall University,
Ibadan, Ibadan, Nigeria (Prof M O Owolabi DrM); Department of TB & Huntington, WV, USA (Prof J Sanabria MD); Department of Nutrition
Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, and Preventive Medicine, Case Western Reserve University, Cleveland,
Mysore, India (Prof M P A DNB); University of Chichester, Chichester, OH, USA (Prof J Sanabria MD); Department of Public Health, Regional
UK (R Pacella PhD); Department of Medical Humanities and Social Health Administration Do Norte I P, Vila Nova De Gaia, Portugal
Medicine, Kosin University, Busan, South Korea (Prof E Park PhD); (J V Santos MD); Department of Medicine, University of Massachusetts
Department of Medicine, Maimonides Medical Center, Brooklyn, NY, Medical School, Worcester, MA, USA (M Sardana MD); Surgery
USA (S Patel MD); Regional Medical Research Centre (S Pati MD), Department, Hamad Medical Corporation, Doha, Qatar (B Sathian PhD);
Division of Noncommunicable Diseases (M Sharma PhD), Indian Faculty of Health & Social Sciences, Bournemouth University,
Council of Medical Research, Bhubaneswar, India; Krishna Institute of Bournemouth, UK (B Sathian PhD); UGC Centre of Advanced Study in
Medical Sciences, Deemed University, Karad, India (S T Patil MPH); Psychology, Utkal University, Bhubaneswar, India (M Satpathy PhD);
International Institute of Health Management Research, New Delhi, Udyam-Global Association for Sustainable Development, Bhubaneswar,
India (A Patle MPH); Population Health Group (Prof G C Patton MD), India (M Satpathy PhD); Department of Public Health Sciences,
Murdoch Childrens Research Institute, Melbourne, VIC, Australia University of North Carolina at Charlotte, Charlotte, NC, USA
(R G Weintraub MB); Clinical Research Department, Diabetes Research (M Sawhney PhD); Market Access, Bayer, Istanbul, Turkey
Society, Hyderabad, India (Prof V R Paturi MD); Clinical Research (M Saylan MD); School of Health Sciences, Federal University of Santa
Department, DiabetOmics, Portland, OR, USA (Prof V R Paturi MD); Catarina, Ararangua, Brazil (Prof I J C Schneider PhD); Department of
Cartagena University, Cartagena, Colombia (Prof D M Pereira PhD); Medical Statistics, Epidemiology and Medical Informatics, University of
Shanghai Mental Health Center, Shanghai Jiao Tong University, Zagreb, Zagreb, Croatia (M Sekerija PhD); Division of Epidemiology and
Shanghai, China (Prof M R Phillips MD); Basic Medical Sciences Prevention of Chronic Noncommunicable Diseases, Croatian Institute of
Department, Durban University of Technology, Durban, South Africa Public Health, Zagreb, Croatia (M Sekerija PhD); Langone Medical
(J D Pillay PhD); Department of Environmental Hygiene, German Center, New York University, New York, NY, USA (A Shafieesabet MD);
Federal Environment Agency, Dessau-Roßlau, Germany (D Plass DrPH); Public Health Division, An-Najah National University, Nablus, Palestine
Institute for Mental Health Policy Research, Centre for Addiction and (A A Shaheen PhD); Department of Molecular Hepatology, Middle East
Mental Health, Toronto, ON, Canada (S Popova PhD); University Liver Disease Center, Tehran, Iran (H Sharafi PhD); Department of
Medical Center Groningen, University of Groningen, Groningen, Laboratory Sciences (Prof M Sharif PhD), Department of Basic Sciences
Netherlands (Prof M J Postma PhD); Ashok & Rita Patel Institute of (Prof M Sharif PhD), Islamic Azad University, Sari, Iran; University
Physiotherapy, Charotar University of Science and Technology, Anand, School of Management and Entrepreneurship, Delhi Technological
India (V Prakash PhD); Independent Consultant, Glenelg, SA, Australia University, New Delhi, India (R Sharma PhD); Department of
(Prof K Pseudovs PhD); Government Medical College, Nagpur, India Pulmonary Medicine, Fudan University, Shanghai, China (J She MD);
(Prof M B Purwar MD); Non-Communicable Diseases Research Center, Usher Institute of Population Health Sciences and Informatics,
Alborz University of Medical Sciences, Karaj, Iran (M Qorbani PhD); University of Edinburgh, Edinburgh, UK (Prof A Sheikh MD,
Department of Environmental & Occupational Health, Drexel I N Soyiri PhD); Independent Consultant, Karachi, Pakistan
University, Philadelphia, PA, USA (D Quistberg PhD); Medichem, (M A Shaikh MD); Friedman School of Nutrition Science and Policy,
Barcelona, Spain (A Radfar MD); Department of Epidemiology & Tufts University, Boston, MA, USA (P Shi PhD); National Institute of
Biostatistics, Contech School of Public Health, Lahore, Pakistan Infectious Diseases, Tokyo, Japan (M Shigematsu PhD); Washington
(A Rafay MS); Department of Clinical Pediatrics, Sweidi Hospital, State University, Pullman, WA, USA (K Shishani PhD); Institute of
Riyadh, Saudi Arabia (Prof S U Rahman MBBS); Department of Medical Epidemiology, Martin Luther University Halle-Wittenberg,
Pediatrics, North-West University, Peshawar, Pakistan Halle, Germany (I Shiue PhD); School of Health, University of
(Prof S U Rahman MBBS); Society for Health and Demographic Technology Sydney, Sydney, NSW, Australia (S Siabani PhD);
Surveillance, Suri, India (R Rai MPH); Department of Economics, Department of Psychology, Reykjavik University, Reykjavik, Iceland
University of Göttingen, Göttingen, Germany (R Rai MPH); Department (Prof I D Sigfusdottir PhD, R Sigurvinsdottir PhD); Brasília University,
of Neurology, Capital & Coast District Health Board, Wellington, Brasília, Brazil (Prof D A Silveira MD); Max Hospital, Ghaziabad, India
New Zealand (A Ranta PhD); University College London Hospitals, (Prof N P Singh MD); Department of Pulmonary Medicine, Asthma
London, UK (D L Rawaf MD); Public Health England, London, UK Bhawan, Jaipur, India (Prof V Singh MD); Department of Epidemiology,
(Prof S Rawaf PhD); Brien Holden Vision Institute, Sydney, NSW, School of Preventive Oncology, Patna, India (D N Sinha PhD); Pediatric
Australia (Prof S Resnikoff MD); Organization for the Prevention of Department, King Khalid University Hospital, Riyadh, Saudi Arabia
Blindness, Paris, France (Prof S Resnikoff MD); Department of Clinical (B H Sobaih MD); Department of Endocrinology and Diabetes, Yaoundé
Research, Federal University of Uberlândia, Uberlândia, Brazil Central Hospital, Yaoundé, Cameroon (Prof E Sobngwi PhD); The
(L Roever PhD); Golestan Research Center of Gastroenterology and Dartmouth Institute for Health Policy, Dartmouth College, Lebanon,
Hepatology, Golestan University of Medical Sciences, Gorgan, Iran NH, USA (S S Soneji PhD); Service of Pulmonology, Health Research
(G Roshandel PhD); Biotechnology, Ikiam Amazon Regional University, Institute of the University Hospital “de la Princesa”, Madrid, Spain
Ciudad De Tena, Ecuador (E Rubagotti PhD); Department of Ocean (Prof J B Soriano MD); Division of Community Medicine, International
Science and Engineering, Southern University of Science and Medical University, Kuala Lumpur, Malaysia (C T Sreeramareddy MD);
Technology, Shenzhen, China (E Rubagotti PhD); Neuropsychiatric Department of Neuromedicine and Movement Science, Norwegian
Institute, Prince of Wales Hospital, Randwick, NSW, Australia University of Science and Technology, Trondheim, Norway
(Prof P S Sachdev MD); Medical Department, University of Sharjah, (Prof T J Steiner PhD, Prof L J Stovner PhD); Neuro Centre, St Olavs
Sharjah, United Arab Emirates (B Saddik PhD); Neurogenic Hospital, Trondheim, Norway (Prof L J Stovner PhD); Department of

Nursing, Muhammadiyah University of Surakarta, Kartasura, Indonesia (S Yahyazadeh Jabbari MD); Wolkite University, Wolkite, Ethiopia
(A Sudaryanto MPH); Department of Community Health (A Yeshaneh BHlthSci); Department of Psychopharmacology, National
(B F Sunguya PhD), Muhimbili University of Health and Allied Center of Neurology and Psychiatry, Tokyo, Japan (N Yonemoto MPH);
Sciences, Dar Es Salaam, Tanzania (B F Sunguya PhD); School of School of Public Health, University of Kinshasa, Kinshasa, Democratic
Medicine, University of California Riverside, Riverside, CA, USA Republic of the Congo (M Yotebieng PhD); Department of Health Policy
(P J Sur MPH); Department of Criminology, Law and Society, University and Management, Jackson State University, Jackson, MS, USA
of California Irvine, Irvine, CA, USA (Prof B L Sykes PhD); Department (Prof M Z Younis DrPH); Tsinghua University, Tsinghua University,
of Medicine (Prof R Tabarés-Seisdedos PhD), Department of Pediatrics, Beijing, China (Prof M Z Younis DrPH); Epidemiology and Cancer
Obstetrics and Gynecology (Prof M Tortajada-Girbés PhD), University of Registry Sector, Institute of Oncology Ljubljana, Ljubljana, Slovenia
Valencia, Valencia, Spain; Carlos III Health Institute, Biomedical (Prof V Zadnik PhD); Epidemiology, University Hospital of Setif, Setif,
Research Networking Center for Mental Health Network (CIBERSAM), Algeria (Prof Z Zaidi PhD); Department of Epidemiology, Human
Madrid, Spain (Prof R Tabarés-Seisdedos PhD); Department of Genetics and Environmental Sciences, University of Texas, Houston, TX,
Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, USA (K Zhang PhD); Noncommunicable Disease Control and
NY, USA (M Tavakkoli MD); University Institute “Egas Moniz”, Monte Prevention Center, Chinese Center for Disease Control and Prevention,
Da Caparica, Portugal (Prof N Taveira PhD); Research Institute for Beijing, China (M Zhou PhD); Israeli Center for Disease Control,
Medicines, Faculty of Pharmacy of Lisbon, University of Lisbon, Lisbon, Ministry of Health, Ramat Gan, Israel (I Zucker MD); and School of
Portugal (Prof N Taveira PhD); Anesthesiology Department, University Public Health, Tel Aviv University, Tel Aviv, Israel (I Zucker MD).
of Virginia, Charlottesville, VA, USA (A S Terkawi MD); Syrian
Contributors
Expatriate Medical Association, Charlottesville, VA, USA
Please see appendix 1 for more detailed information about individual
(A S Terkawi MD); Department of Medicine, University of Calgary,
authors’ contributions to the research, divided into the following
Calgary, AB, Canada (Prof M Tonelli MD); Agency for Health Technology
categories: managing the estimation process; writing the first draft of the
Assessment and Tariff System, Warszawa, Poland (R Topor-Madry PhD);
manuscript; providing data or critical feedback on data sources;
Pediatric Department, University Hospital Doctor Peset, Valencia, Spain
developing methods or computational machinery; applying analytical
(Prof M Tortajada-Girbés PhD); Nutritional Epidemiology Research
methods to produce estimates; providing critical feedback on methods or
Team, National Institute of Health and Medical Research, Paris, France
results; drafting the work or revising it critically for important intellectual
(M Touvier PhD); Department of Health Economics, Hanoi Medical
content; extracting, cleaning, or cataloguing data; designing or coding
University, Hanoi, Vietnam (B X Tran PhD); Clinical Hematology and
figures and tables; and managing the overall research enterprise.
Toxicology, Military Medical University, Hanoi, Vietnam (K B Tran MD);
Medical Department, University of Crete, Heraklion, Greece Declaration of interests
(Prof M K Tsilimbaris MD); Lee Kong Chian School of Medicine, Carl Abelardo Antonio reports personal fees from Johnson & Johnson
Nanyang Technological University, Singapore, Singapore (Philippines). Yannick Bejot reports grants and personal fees from
(L Tudor Car PhD); CV Medicine, Cleveland Clinic Abu Dhabi, AstraZeneca and Boehringer-Ingelheim and personal fees from
Abu Dhabi, United Arab Emirates (Prof E Tuzcu MD); Department of Daiichi-Sankyo, BMS, Pfizer, Medtronic, Bayer, Novex pharma, and
Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria Merck Sharp & Dohme. Boris Bikbov has received funding from the
(K N Ukwaja MD); Gomal Center of Biochemistry and Biotechnology, European Union’s Horizon 2020 research and innovation programme
Gomal University, Dera Ismail Khan, Pakistan (I Ullah PhD); TB Culture under Marie Sklodowska-Curie grant agreement No. 703226. Boris
Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Bikbov acknowledges that work related to this paper has been done on
Khan, Pakistan (I Ullah PhD); School of Government, Pontifical Catholic the behalf of the GBD Genitourinary Disease Expert Group. Cyrus
University of Chile, Santiago, Chile (E A Undurraga PhD); Schneider Cooper reports personal fees from Alliance for Better Bone Health,
Institutes for Health Policy, Brandeis University, Waltham, MA, USA Amgen, Eli Lilly, GlaxoSmithKline, Medtronic, Merck &Co, Novartis,
(E A Undurraga PhD); Argentine Society of Medicine, Ciudad De Pfizer, Roche, Servier, Takeda, and UCB. Louisa Degenhardt reports
Buenos Aires, Argentina (Prof P R Valdez Med); Velez Sarsfield grants from Indivior, Mundipharma, and Seqirus. Seana Gall reports
Hospital, Buenos Aires, Argentina (Prof P R Valdez Med); UKK grants from the National Health and Medical Research Council and the
Institute, Tampere, Finland (Prof T J Vasankari MD); Raffles National Heart Foundation of Australia. Panniyammakal Jeemon reports
Neuroscience Centre, Raffles Hospital, Singapore, Singapore a Clinical and Public Health Intermediate Fellowship from the Wellcome
(Prof N Venketasubramanian MBBS); Occupational Health Unit, Trust–DBT India Alliance (2015–20). Jacek Jóźwiak reports a grant from
Sant’Orsola Malpighi Hospital, Bologna, Italy (Prof F S Violante MPH); Valeant, personal fees from Valeant, ALAB Laboratoria and Amgen, and
Federal Research Institute for Health Organization and Informatics of non-financial support from Microlife and Servier. Nicholas Kassebaum
the Ministry of Health, Moscow, Russia (S K Vladimirov PhD); reports personal fees and other support from Vifor Pharmaceuticals.
Department of Information and Internet Technologies, I M Sechenov Srinivasa Vittal Katikireddi reports grants from NHS Research Scotland,
First Moscow State Medical University, Moscow, Russia the Medical Research Council, and the Scottish Government Chief
(S K Vladimirov PhD); Department of Health Care Administration and Scientist Office. Jeffrey Lazarus reports personal fees from Janssen and
Economy, National Research University Higher School of Economics, CEPHEID and grants and personal fees from AbbVie, Gilead Sciences,
Moscow, Russia (Prof V Vlassov MD); Foundation University Medical and Merck Sharp & Dohme. Stefan Lorkowski reports personal fees
College, Foundation University, Rawalpindi, Pakistan (Y Waheed PhD); from Amgen, Berlin-Chemie, Merck Sharp & Dohme, Novo Nordisk,
Department of Preventive Medicine and Biostatistics, Uniformed Sanofi-Aventis, Synlab, Unilever, and non-financial support from
Services University of Health Sciences, Bethesda, MD, USA Preventicus. Winfried März reports grants and personal fees from
(Prof S G Waller MD); Department of Epidemiology and Biostatistics Siemens Diagnostics, Aegerion Pharmaceuticals, Amgen, AstraZeneca,
(Y Wang BSA, Prof C Yu PhD), Global Health Institute (Prof C Yu PhD), Danone Research, Pfizer, BASF, Numares, and Berline-Chemie;
Wuhan University, Wuhan, China; Department of Research, Cancer personal fees from Hoffmann LaRoche, Merck Sharp & Dohme, Sanofi,
Registry of Norway, Oslo, Norway (Prof E Weiderpass PhD); and Synageva; grants from Abbott Diagnostics; and other support from
Independent Consultant, Staufenberg, Germany (A Werdecker PhD); Synlab. Walter Mendoza is currently a Program Analyst for Population
Department of Neurology, Technical University of Munich, Munich, and Development at the Peru Country Office of the United Nations
Germany (A S Winkler PhD); Bone and Joint Research Group, Royal Population Fund. Ted Miller reports an evaluation contract from
Cornwall Hospital, Truro, UK (Prof A D Woolf BSc); Kailuan General AB InBev Foundation. Maarten Postma reports grants from
Hospital, Kailuan General Hospital, Tangshan, China (Prof S Wu PhD); Mundipharma, Bayer, BMS, AstraZeneca, ARTEG, and AscA; grants and
University of Strathclyde, Glasgow, UK (G M A Wyper MSc); personal fees from Sigma Tau, Merck Sharp & Dohme,
Department of Pharmacology, St John’s National Academy of Health GlaxoSmithKline, Pfizer, Boehringer-Ingelheim, Novavax, Ingress
Sciences, Bangalore, India (Prof D Xavier MD); School of Medicine, Health, AbbVie, and Sanofi; personal fees from Quintiles, Astellas, Mapi,
Nanjing University, Nanjing, China (Prof G Xu MD); Clinical Cancer OptumInsight, Novartis, Swedish Orphan, Innoval, Jansen, Intercept,
Research Center, Milad General Hospital, Tehran, Iran and Pharmerit, and stock ownership in Ingress Health and

Pharmacoeconomics Advice Groningen. Kazem Rahimi reports grants with the General Statistics Law, 2000. The researchers are solely
from the National Institute for Health Research Biomedical Research responsible for the conclusions and inferences drawn upon available
Centre, the Economic and Social Research Council, and Oxford Martin data. This paper uses data from SHARE Waves 1, 2, 3 (SHARELIFE), 4, 5
For more on SHARE see School. Kenji Shibuya reports grants from the Ministry of Health, and 6 (DOIs: 10.6103/SHARE.w1.611, 10.6103/SHARE.w2.611, 10.6103/
http://www.share-project.org Labour, and Welfare and from the Ministry of Education, Culture, SHARE.w3.611, 10.6103/SHARE.w4.611, 10.6103/SHARE.w5.611,
Sports, Science, and Technology. Mark Shrime reports grants from 10.6103/SHARE.w6.611); see Börsch-Supan et al (2013) for
Mercy Ships and Damon Runyon Cancer Research Foundation. methodological details. The SHARE data collection has been primarily
Jasvinder Singh reports consulting for Horizon, Fidia, UBM, Medscape, funded by the European Commission through FP5 (QLK6-
WebMD, the National Institutes of Health, and the American College of CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE:
Rheumatology; they serve as the principal investigator for an CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7
investigator-initiated study funded by Horizon pharmaceuticals through (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4:
a grant to DINORA, a 501c3 entity; they are on the steering committee of N°261982). Additional funding from the German Ministry of Education
OMERACT, an international organisation that develops measures for and Research, the Max Planck Society for the Advancement of Science,
clinical trials and receives arms-length funding from 36 pharmaceutical the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842,
companies. Jeffrey Stanaway reports a grant from Merck & Co. P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01,
Denis Xavier reports grants from Cadila Pharmaceuticals, Boehringer IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from
Ingelheim, Sanofi Aventis, Pfizer, and Bristol-Myers Squibb. various national funding sources is gratefully acknowledged by SHARE.
This study was realised using data collected by the Swiss Household
Data sharing
Panel, which is based at the Swiss Centre of Expertise in the Social
To download the data used in these analyses, please visit the Global
Sciences FORS. The project is financed by the Swiss National Science
Health Data Exchange at http://ghdx.healthdata.org/gbd−2017.
Foundation. Data reported here were supplied by the United States
Acknowledgments Renal Data System. The interpretation and reporting of these data are
Research reported in this publication was supported by the Bill & the responsibility of the authors and in no way should be seen as an
Melinda Gates Foundation, the University of Melbourne, Public Health official policy or interpretation of the US Government.
England, the Norwegian Institute of Public Health, St Jude Children’s
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Global Health Metrics

Global, regional, and national incidence, prevalence, and

Funding Bill & Melinda Gates Foundation.

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Communicable, maternal, neonatal, Non-communicable diseases Injuries

Year Year Year

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